Provider Demographics
NPI:1922420983
Name:COASTAL VIEW GASTROENTEROLOGY OF SOUTH BAY, INC.
Entity Type:Organization
Organization Name:COASTAL VIEW GASTROENTEROLOGY OF SOUTH BAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-560-0695
Mailing Address - Street 1:3440 LOMITA BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4829
Mailing Address - Country:US
Mailing Address - Phone:424-250-9186
Mailing Address - Fax:323-300-2021
Practice Address - Street 1:3440 LOMITA BLVD STE 420
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4829
Practice Address - Country:US
Practice Address - Phone:424-250-9186
Practice Address - Fax:323-300-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85817207RG0100X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I29994Medicare UPIN