Healthcare Provider Details

I. General information

NPI: 1336664424
Provider Name (Legal Business Name): COASTAL RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MACARTHUR PL STE 300
SANTA ANA CA
92707-5924
US

IV. Provider business mailing address

PO BOX 200077
DALLAS TX
75320-0077
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-3573
  • Fax:
Mailing address:
  • Phone: 833-417-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026