MEDICARE: DR. RAUL S COIMBRA M.D./PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0127X	Trauma Surgery Physician	A74573	CA
2	2086S0102X	Surgical Critical Care Physician	A74573	CA
3	208600000X	Surgery Physician	A74573	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356372791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL S COIMBRA M.D./PH.D

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:	MAIL CODE 8896
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-7024
Fax Number	:	619-543-7202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/02/2019

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Directions to “ DR. RAUL S COIMBRA M.D./PH.D” Practice Location

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