Healthcare Provider Details

I. General information

NPI: 1922943083
Provider Name (Legal Business Name): COAST 2 COAST CONSULT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21515 VANOWEN ST
CANOGA PARK CA
91303-2715
US

IV. Provider business mailing address

21515 VANOWEN ST
CANOGA PARK CA
91303-2715
US

V. Phone/Fax

Practice location:
  • Phone: 818-522-3732
  • Fax:
Mailing address:
  • Phone: 818-522-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MANUEL A MARTINEZ JR.
Title or Position: CFO
Credential:
Phone: 818-522-3732