Provider Demographics
NPI:1609578798
Name:COASTAL ENDOCRINOLOGY INC
Entity Type:Organization
Organization Name:COASTAL ENDOCRINOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GABIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-5338
Mailing Address - Street 1:31852 COAST HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6765
Mailing Address - Country:US
Mailing Address - Phone:949-499-5338
Mailing Address - Fax:
Practice Address - Street 1:31852 COAST HWY STE 202
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6765
Practice Address - Country:US
Practice Address - Phone:949-499-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty