Healthcare Provider Details

I. General information

NPI: 1588086136
Provider Name (Legal Business Name): COASTAL MATERNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 DONDEE ST STE 5
PACIFICA CA
94044-3258
US

IV. Provider business mailing address

PO BOX 743
PACIFICA CA
94044-0743
US

V. Phone/Fax

Practice location:
  • Phone: 415-649-6262
  • Fax: 415-649-6262
Mailing address:
  • Phone: 415-649-6262
  • Fax: 415-649-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL10992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number225
License Number StateCA

VIII. Authorized Official

Name: SHARON ECONOMIDES
Title or Position: OWNER, MIDWIFE, LACTATION CONSULTAN
Credential: LM, CPM, IBCLC
Phone: 415-649-6262