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General NPI Number Information
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NPI Number | 1114119393
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Entity Type | Organization
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Legal Business Name | COASTAL AESTHETIC CENTER PA
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 301 HEALTH PARK BLVD STE 109
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5794
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Country | US
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Telephone | 904-245-1320
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Fax | 866-878-2261
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32085-3123
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Country | US
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Telephone | 904-245-1320
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Fax | 866-878-2261
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Authorized Official
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Title or Position | OWNER
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Name | ANH VU
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Credential | MD
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Telephone | 904-245-1320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | ME99062
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License Number State | FL
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