Provider Demographics
NPI:1710235569
Name:WEST COAST PEDIATRICS
Entity Type:Organization
Organization Name:WEST COAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES-LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-761-0663
Mailing Address - Street 1:1414 59TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4607
Mailing Address - Country:US
Mailing Address - Phone:941-761-0663
Mailing Address - Fax:941-761-3347
Practice Address - Street 1:1414 59TH STREET WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4607
Practice Address - Country:US
Practice Address - Phone:941-761-0663
Practice Address - Fax:941-761-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty