Healthcare Provider Details

I. General information

NPI: 1326368051
Provider Name (Legal Business Name): COASTAL CHILDRENS SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6338
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-5011
  • Fax: 910-772-9452
Mailing address:
  • Phone: 910-667-2970
  • Fax: 910-667-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FERNANDO MOYA
Title or Position: PRESIDENT
Credential: MD
Phone: 910-667-2970