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General NPI Number Information
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NPI Number | 1154455541
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Entity Type | Organization
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Legal Business Name | COAST ORTHOPEDIC SPECIALTY ASSOCIATES
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 78 S MAIN ST
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City | TEMPLETON
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State | CA
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Zip | 93465-9787
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Country | US
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Telephone | 805-434-0999
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Fax | 805-434-5267
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Provider Business Mailing Address
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Address Line | 78 S MAIN ST
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City | TEMPLETON
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State | CA
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Zip | 93465-9787
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Country | US
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Telephone | 805-434-0999
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Fax | 805-434-5267
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Authorized Official
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Title or Position | OWNER
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Name | MARK G KOWALL
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Credential | MD
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Telephone | 805-466-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G074354
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License Number State | CA
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