Provider Demographics
NPI:1770188658
Name:COASTAL PHYSICIAN GROUP PA
Entity Type:Organization
Organization Name:COASTAL PHYSICIAN GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:CISNEROS
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:361-883-8887
Mailing Address - Street 1:6113 SARATOGA BLVD
Mailing Address - Street 2:SUITE F #148
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2492
Mailing Address - Country:US
Mailing Address - Phone:361-883-8887
Mailing Address - Fax:361-792-2513
Practice Address - Street 1:345 S WATER ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2819
Practice Address - Country:US
Practice Address - Phone:361-500-0600
Practice Address - Fax:361-500-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty