Healthcare Provider Details

I. General information

NPI: 1629428933
Provider Name (Legal Business Name): COAST TO COAST ENDOCRINOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14271 JEFFREY RD 238
IRVINE CA
92620-3405
US

IV. Provider business mailing address

14271 JEFFREY RD 238
IRVINE CA
92620-3405
US

V. Phone/Fax

Practice location:
  • Phone: 949-290-9186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMRIT PAL SINGH BHANGOO
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 949-290-9186