Healthcare Provider Details

I. General information

NPI: 1083179360
Provider Name (Legal Business Name): COASTAL HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 THIRD STREET SUITE 13
POINT REYES STATION CA
94956
US

IV. Provider business mailing address

PO BOX 910
POINT REYES STATION CA
94956-0910
US

V. Phone/Fax

Practice location:
  • Phone: 415-787-1123
  • Fax:
Mailing address:
  • Phone: 415-663-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DINELLE MARIE ABRAM
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 415-663-8781