Healthcare Provider Details

I. General information

NPI: 1326112152
Provider Name (Legal Business Name): COASTAL COMMUNITIES HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

IV. Provider business mailing address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-5454
  • Fax:
Mailing address:
  • Phone: 714-754-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. PATRICIA HENRY
Title or Position: CFO
Credential:
Phone: 714-754-4985