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General NPI Number Information
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NPI Number | 1164052163
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Entity Type | Organization
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Legal Business Name | COASTAL INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 01/19/2020
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Last Update Date | 01/19/2020
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Provider Practice Location Address
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Address Line | 2400 TEMPLE HILLS DR
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2668
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Country | US
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Telephone | 949-943-9068
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 TEMPLE HILLS DR
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2668
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Country | US
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Telephone | 949-943-9068
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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. POURYA MIRSAEID MIRSAEID GHAZI
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Credential | MD
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Telephone | 949-943-9068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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