Healthcare Provider Details

I. General information

NPI: 1528860459
Provider Name (Legal Business Name): COASTAL IMAGING AND INTERVENTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LA PALMA AVE
ANAHEIM CA
92801-2804
US

IV. Provider business mailing address

PO BOX 60049
ARCADIA CA
91066-6049
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-3847
  • Fax: 714-999-6127
Mailing address:
  • Phone: 626-698-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REZA SHAHBAZ
Title or Position: PRESIDENT
Credential: MD
Phone: 714-999-6000