Provider Demographics
NPI:1770816852
Name:COASTAL CANCER CARE INC.
Entity Type:Organization
Organization Name:COASTAL CANCER CARE INC.
Other - Org Name:TODD YATES D.O.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-981-0808
Mailing Address - Street 1:1901 SOLAR DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2641
Mailing Address - Country:US
Mailing Address - Phone:805-981-0808
Mailing Address - Fax:
Practice Address - Street 1:1901 SOLAR DR
Practice Address - Street 2:SUITE 240
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2641
Practice Address - Country:US
Practice Address - Phone:805-981-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10187207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710197447OtherINDIVIDUAL NPI
CA1710197447OtherINDIVIDUAL NPI