Provider Demographics
NPI:1205947389
Name:NORTH COAST WOMEN'S CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:NORTH COAST WOMEN'S CARE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOOPACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-758-3000
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-758-3000
Mailing Address - Fax:760-758-5943
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-758-3000
Practice Address - Fax:760-758-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP20895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082190Medicaid
CAW10862Medicare ID - Type Unspecified