Healthcare Provider Details

I. General information

NPI: 1720747389
Provider Name (Legal Business Name): COAST PEDIATRICS 4S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17085 CAMINO SAN BERNARDO
SAN DIEGO CA
92127-5709
US

IV. Provider business mailing address

12845 POINTE DEL MAR WAY STE 200
DEL MAR CA
92014-3862
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-7337
  • Fax: 858-794-7338
Mailing address:
  • Phone: 858-794-7337
  • Fax: 858-794-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI TAYLOR
Title or Position: PRACTICE CO-OWNER
Credential: MD
Phone: 858-794-7337