Provider Demographics
NPI:1891812483
Name:COASTAL BEND WOMENS CENTER
Entity Type:Organization
Organization Name:COASTAL BEND WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-993-6000
Mailing Address - Street 1:7121 S PADRE ISLAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4940
Mailing Address - Country:US
Mailing Address - Phone:361-993-6000
Mailing Address - Fax:361-985-1152
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-993-6000
Practice Address - Fax:361-985-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00CB64OtherBLUE CROSS BLUE SHIELD
TX112634401Medicaid
00CB64Medicare PIN