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General NPI Number Information
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NPI Number | 1083870745
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Entity Type | Organization
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Legal Business Name | COASTAL CARDIOVASCULAR ASSOCIATES PA
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 7752 BAY ST SUITE 6
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-589-3000
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Fax | 772-589-3003
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Provider Business Mailing Address
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Address Line | 7752 BAY ST SUITE 6
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-589-3000
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Fax | 772-589-3003
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PATRICIA A WOLFF
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Credential |
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Telephone | 772-589-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME100741
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License Number State | FL
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