Provider Demographics
NPI:1851405765
Name:COASTAL PSYCHIATRIC MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:COASTAL PSYCHIATRIC MEDICAL ASSOCIATES, INC.
Other - Org Name:COASTAL MANAGEMENT SERVICE ORGANIZATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-405-4423
Mailing Address - Street 1:1959 GRAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4511
Mailing Address - Country:US
Mailing Address - Phone:858-405-4423
Mailing Address - Fax:858-581-5788
Practice Address - Street 1:12520 HIGH BLUFF DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2041
Practice Address - Country:US
Practice Address - Phone:858-405-4423
Practice Address - Fax:858-581-5788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20859103TC0700X
CALCS 219091041C0700X
CALCS183311041C0700X
CALCS 176401041C0700X
CALCS 216661041C0700X
CALCS 181491041C0700X
CAMFC 24183106H00000X
CAMFC 19749106H00000X
CAMFC 41302106H00000X
CAMFC 35861106H00000X
CAG645712084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX IDENTIFICATION NUMBER