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General NPI Number Information
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NPI Number | 1104842491
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Entity Type | Organization
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Legal Business Name | COASTAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2406 TORRANCE BLVD
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City | TORRANCE
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State | CA
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Zip | 90501-2401
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Country | US
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Telephone | 310-328-3421
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Fax | 310-328-3429
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Provider Business Mailing Address
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Address Line | PO BOX 4269
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City | PALOS VERDES ESTATES
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State | CA
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Zip | 90274-9577
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Country | US
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Telephone | 310-328-3421
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Fax | 310-329-3429
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Authorized Official
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Title or Position | SOLE SHARE HOLDER
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Name | DR. JEFFERY ADAM OSTRIKER
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Credential | M.D.
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Telephone | 310-328-3421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G48181
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License Number State | CA
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