Provider Demographics
NPI:1780888321
Name:COASTAL PEDIATRICS
Entity type:Organization
Organization Name:COASTAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-672-1490
Mailing Address - Street 1:1275 W GRANADA BLVD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8259
Mailing Address - Country:US
Mailing Address - Phone:386-672-1490
Mailing Address - Fax:386-672-1628
Practice Address - Street 1:1275 W GRANADA BLVD
Practice Address - Street 2:SUITE 3A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8259
Practice Address - Country:US
Practice Address - Phone:386-672-1490
Practice Address - Fax:386-672-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty