Healthcare Provider Details

I. General information

NPI: 1578486338
Provider Name (Legal Business Name): COASTAL CONCIERGE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 A AVE
CORONADO CA
92118-2628
US

IV. Provider business mailing address

917 A AVE
CORONADO CA
92118-2628
US

V. Phone/Fax

Practice location:
  • Phone: 619-675-9502
  • Fax: 619-566-4943
Mailing address:
  • Phone: 619-675-9502
  • Fax: 619-566-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HOLMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 619-762-4991