Provider Demographics
NPI:1790593903
Name:COASTAL INFUSION LLC
Entity type:Organization
Organization Name:COASTAL INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGUIRISTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-394-3063
Mailing Address - Street 1:4331 N FEDERAL HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5252
Mailing Address - Country:US
Mailing Address - Phone:954-361-1000
Mailing Address - Fax:954-361-8699
Practice Address - Street 1:475 BILTMORE WAY STE 101A
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5724
Practice Address - Country:US
Practice Address - Phone:954-361-1000
Practice Address - Fax:954-361-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty