Provider Demographics
NPI:1912308446
Name:COAST PLAZA EMERGENCY PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:COAST PLAZA EMERGENCY PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-698-5474
Mailing Address - Street 1:PO BOX 80481
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8404
Mailing Address - Country:US
Mailing Address - Phone:866-898-7148
Mailing Address - Fax:904-805-1037
Practice Address - Street 1:13100 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2531
Practice Address - Country:US
Practice Address - Phone:562-868-3751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223466Medicare PIN