Provider Demographics
NPI:1720240872
Name:COASTAL ALLERGY CARE INC
Entity Type:Organization
Organization Name:COASTAL ALLERGY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-482-8989
Mailing Address - Street 1:2412 N PONDEROSA DR STE B111
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2379
Mailing Address - Country:US
Mailing Address - Phone:805-482-8989
Mailing Address - Fax:805-987-2855
Practice Address - Street 1:2412 N PONDEROSA DR STE B111
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2379
Practice Address - Country:US
Practice Address - Phone:805-482-8989
Practice Address - Fax:805-987-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34328174400000X
CAA74064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty