Healthcare Provider Details

I. General information

NPI: 1245291988
Provider Name (Legal Business Name): COASTAL ORTHOPAEDICS & SPORTS MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 S US HIGHWAY 1
PORT SAINT LUCIE FL
34952-2320
US

IV. Provider business mailing address

7710 S US HIGHWAY 1
PORT SAINT LUCIE FL
34952-2320
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-5300
  • Fax: 772-873-3004
Mailing address:
  • Phone: 772-335-5300
  • Fax: 772-873-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: EDWARD JESUS ROSSARIO
Title or Position: PRESIDENT
Credential: MD
Phone: 772-335-5300