Provider Demographics
NPI:1851712681
Name:COASTLINE MED MANAGEMENT INC.
Entity Type:Organization
Organization Name:COASTLINE MED MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-515-5607
Mailing Address - Street 1:300 S HARBOR BLVD
Mailing Address - Street 2:#920
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3733
Mailing Address - Country:US
Mailing Address - Phone:714-515-5607
Mailing Address - Fax:
Practice Address - Street 1:300 S HARBOR BLVD
Practice Address - Street 2:#920
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3733
Practice Address - Country:US
Practice Address - Phone:714-515-5607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management