Healthcare Provider Details

I. General information

NPI: 1750173357
Provider Name (Legal Business Name): GOLDEN COAST REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8809 LA MESA BLVD STE 102
LA MESA CA
91942-5406
US

IV. Provider business mailing address

14 ALEWIVE BROOK RD
EAST HAMPTON NY
11937-1190
US

V. Phone/Fax

Practice location:
  • Phone: 858-925-8589
  • Fax: 858-863-5017
Mailing address:
  • Phone: 858-925-8589
  • Fax: 858-863-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN SCADUTO
Title or Position: FOUNDER
Credential:
Phone: 858-925-8589