Healthcare Provider Details

I. General information

NPI: 1891064713
Provider Name (Legal Business Name): COASTLINE THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 CENTER AVE SUITE 104
HUNTINGTON BEACH CA
92647-3094
US

IV. Provider business mailing address

7400 CENTER AVE SUITE 104
HUNTINGTON BEACH CA
92647-3094
US

V. Phone/Fax

Practice location:
  • Phone: 714-292-2322
  • Fax: 714-866-4153
Mailing address:
  • Phone: 714-292-2322
  • Fax: 714-866-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP9675
License Number StateCA

VIII. Authorized Official

Name: MRS. KAREN VESCIAL
Title or Position: SPEECH THERAPIST
Credential: MS CCC/SLP
Phone: 714-292-2322