Healthcare Provider Details

I. General information

NPI: 1790593903
Provider Name (Legal Business Name): COASTAL INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BILTMORE WAY STE 101A
CORAL GABLES FL
33134-5724
US

IV. Provider business mailing address

4331 N FEDERAL HWY STE 300
FORT LAUDERDALE FL
33308-5252
US

V. Phone/Fax

Practice location:
  • Phone: 954-361-1000
  • Fax: 954-361-8699
Mailing address:
  • Phone: 954-361-1000
  • Fax: 954-361-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BEGUIRISTAIN
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 786-394-3063