Healthcare Provider Details

I. General information

NPI: 1245643279
Provider Name (Legal Business Name): COASTAL DIAGNOSTIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 615
ORANGE CA
92868-4310
US

IV. Provider business mailing address

PO BOX 61327
IRVINE CA
92602-6044
US

V. Phone/Fax

Practice location:
  • Phone: 888-268-8607
  • Fax: 951-461-7074
Mailing address:
  • Phone: 888-268-8607
  • Fax: 951-461-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: STEVE WONG
Title or Position: OWNER
Credential:
Phone: 888-268-8607