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General NPI Number Information
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NPI Number | 1043453640
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOPEDICS & SPORTS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 04/13/2009
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Provider Practice Location Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-4514
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Country | US
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Telephone | 760-724-5173
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Fax |
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Provider Business Mailing Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-4514
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Country | US
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Telephone | 760-724-5173
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RODMAN ST. CLAIR SR.
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Credential | M.D.
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Telephone | 909-605-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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