Provider Demographics
NPI:1982629770
Name:PACIFIC COAST WOMEN'S HLTH
Entity Type:Organization
Organization Name:PACIFIC COAST WOMEN'S HLTH
Other - Org Name:PACIFIC COAST WOMEN'S HEALTH MEDICAL GROUP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-944-1000
Mailing Address - Street 1:317 N. EL CAMINO REAL
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-944-1000
Mailing Address - Fax:760-944-1123
Practice Address - Street 1:317 N. EL CAMINO REAL
Practice Address - Street 2:SUITE 306
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-944-1000
Practice Address - Fax:760-944-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17935Medicare UPIN
CAH81860Medicare UPIN
CAW14347Medicare PIN