Healthcare Provider Details

I. General information

NPI: 1801011697
Provider Name (Legal Business Name): NORTH COAST CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SANTA FE DR STE 1
ENCINITAS CA
92024-5137
US

IV. Provider business mailing address

351 SANTA FE DR STE 1
ENCINITAS CA
92024-5137
US

V. Phone/Fax

Practice location:
  • Phone: 760-635-2426
  • Fax: 760-753-2506
Mailing address:
  • Phone: 760-635-2426
  • Fax: 760-753-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberHK07-1232426HK58
License Number StateCA

VIII. Authorized Official

Name: MS. NAKESHA JOHNSON
Title or Position: BILLING MANAGER
Credential:
Phone: 760-635-2426