Healthcare Provider Details

I. General information

NPI: 1679562201
Provider Name (Legal Business Name): COASTAL HOSPITALIST MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

IV. Provider business mailing address

5050 AVENIDA ENCINAS SUITE 230
CARLSBAD CA
92008-4381
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-6581
  • Fax: 760-769-6585
Mailing address:
  • Phone: 760-439-6581
  • Fax: 760-439-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040