Provider Demographics
NPI:1639408974
Name:COASTAL BEND PRIMARY CARE CORP
Entity Type:Organization
Organization Name:COASTAL BEND PRIMARY CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-654-0050
Mailing Address - Street 1:4621 S STAPLES
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2605
Mailing Address - Country:US
Mailing Address - Phone:361-654-0050
Mailing Address - Fax:361-654-0056
Practice Address - Street 1:4621 S STAPLES
Practice Address - Street 2:SUITE A
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2605
Practice Address - Country:US
Practice Address - Phone:361-654-0050
Practice Address - Fax:361-654-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXL8345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty