Provider Demographics
NPI:1205266228
Name:COASTAL MEDICAL GROUP
Entity type:Organization
Organization Name:COASTAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-464-8484
Mailing Address - Street 1:11920 ASTORIA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6097
Mailing Address - Country:US
Mailing Address - Phone:281-464-8484
Mailing Address - Fax:281-464-8432
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6097
Practice Address - Country:US
Practice Address - Phone:281-464-8484
Practice Address - Fax:281-464-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710374283X00000X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No283X00000XHospitalsRehabilitation Hospital