Healthcare Provider Details

I. General information

NPI: 1083467880
Provider Name (Legal Business Name): COASTAL RHEUMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 PINES BLVD STE 110
PEMBROKE PINES FL
33024-6461
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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