Healthcare Provider Details

I. General information

NPI: 1326337270
Provider Name (Legal Business Name): COASTAL VIEW GASTROENTEROLOGY OF SOUTH BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD SUITE 420
TORRANCE CA
90505-4801
US

IV. Provider business mailing address

3440 LOMITA BLVD SUITE 420
TORRANCE CA
90505
US

V. Phone/Fax

Practice location:
  • Phone: 310-997-1796
  • Fax:
Mailing address:
  • Phone: 424-250-9179
  • Fax: 323-300-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA85817
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. SUTHA SACHAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-560-0695