Healthcare Provider Details

I. General information

NPI: 1497013627
Provider Name (Legal Business Name): COAST PEDIATRICS DEL MAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 POINTE DEL MAR WAY
DEL MAR CA
92014-3862
US

IV. Provider business mailing address

12845 POINTE DEL MAR WAY
DEL MAR CA
92014-3862
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-7337
  • Fax: 858-777-5492
Mailing address:
  • Phone: 858-794-7337
  • Fax: 858-777-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI BETH TAYLOR
Title or Position: PARTNER
Credential: M.D.
Phone: 858-335-5043