Healthcare Provider Details

I. General information

NPI: 1780888321
Provider Name (Legal Business Name): COASTAL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W GRANADA BLVD SUITE 3A
ORMOND BEACH FL
32174-8259
US

IV. Provider business mailing address

1275 W GRANADA BLVD SUITE 3A
ORMOND BEACH FL
32174-8259
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-1490
  • Fax: 386-672-1628
Mailing address:
  • Phone: 386-672-1490
  • Fax: 386-672-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN CLAUDE JEANTY
Title or Position: OWNER
Credential: M.D.
Phone: 386-672-1490