Provider Demographics
NPI:1780998005
Name:COASTAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:COASTAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUNISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-847-0800
Mailing Address - Street 1:12264 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3058
Mailing Address - Country:US
Mailing Address - Phone:858-847-0800
Mailing Address - Fax:858-724-0450
Practice Address - Street 1:12264 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3058
Practice Address - Country:US
Practice Address - Phone:858-847-0800
Practice Address - Fax:858-724-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG832462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty