Provider Demographics
NPI:1790265445
Name:COASTAL CARDIOVASCULAR CARE INC
Entity Type:Organization
Organization Name:COASTAL CARDIOVASCULAR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHBOOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-452-6334
Mailing Address - Street 1:477 N EL CAMINO REAL STE C204
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1332
Mailing Address - Country:US
Mailing Address - Phone:760-230-2256
Mailing Address - Fax:760-452-2664
Practice Address - Street 1:700 GARDEN VIEW CT STE 204
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-452-6334
Practice Address - Fax:760-634-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119955207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty