Healthcare Provider Details

I. General information

NPI: 1740356005
Provider Name (Legal Business Name): COAST MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N EL CAMINO REAL STE 100
ENCINITAS CA
92024-5821
US

IV. Provider business mailing address

227 N EL CAMINO REAL STE 100
ENCINITAS CA
92024-5821
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-5000
  • Fax: 760-436-9700
Mailing address:
  • Phone: 760-436-5000
  • Fax: 760-944-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA83666
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG70448
License Number StateCA

VIII. Authorized Official

Name: MR. STEVEN WILLIAMSON
Title or Position: OWNER
Credential:
Phone: 760-436-5000