=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164763504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COAST URGENT CARE AND FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2013
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 S COAST HWY
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92054-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-533-2384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 S COAST HWY
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92054-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-533-2384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. MARK MELDEN
-----------------------------------------------------
Credential | D.O
-----------------------------------------------------
Telephone | 760-533-2384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | C3520529
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------