Healthcare Provider Details

I. General information

NPI: 1073384228
Provider Name (Legal Business Name): COASTAL RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 N FEDERAL HWY STE 301
FT LAUDERDALE FL
33308-5252
US

IV. Provider business mailing address

4700 SHERIDAN ST STE C
HOLLYWOOD FL
33021-3416
US

V. Phone/Fax

Practice location:
  • Phone: 954-237-3000
  • Fax: 954-837-9299
Mailing address:
  • Phone: 954-237-3000
  • Fax: 954-837-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BEGUIRISTAIN
Title or Position: DIRECTOR, BUSINESS DEVELOPEMENT
Credential:
Phone: 786-394-3063