Healthcare Provider Details

I. General information

NPI: 1346019254
Provider Name (Legal Business Name): COASTAL WOUND SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 N EL CAMINO REAL STE B385
ENCINITAS CA
92024-1334
US

IV. Provider business mailing address

1084 N EL CAMINO REAL STE B385
ENCINITAS CA
92024-1334
US

V. Phone/Fax

Practice location:
  • Phone: 619-997-8425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW COOPER
Title or Position: OWNER MD
Credential: MD
Phone: 858-485-1494