Provider Demographics
NPI:1821031675
Name:COASTAL VASCULAR CENTER PC
Entity Type:Organization
Organization Name:COASTAL VASCULAR CENTER PC
Other - Org Name:COASTAL VASCULAR CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-983-6233
Mailing Address - Street 1:1901 OUTLET CENTER DRIVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-6073
Mailing Address - Country:US
Mailing Address - Phone:805-983-6233
Mailing Address - Fax:805-983-2459
Practice Address - Street 1:2841 N VENTURA RD STE 200
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2213
Practice Address - Country:US
Practice Address - Phone:805-983-6233
Practice Address - Fax:805-983-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14567OtherMEDICARE ID UNSPECIFIED
CAW14567OtherMEDICARE ID UNSPECIFIED