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General NPI Number Information
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NPI Number | 1255620522
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Entity Type | Organization
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Legal Business Name | PACIFIC COAST MEDICINE, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 361 HOSPITAL RD STE 227
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3523
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Country | US
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Telephone | 949-436-7294
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Fax | 949-612-1690
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD STE 614
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 949-436-7294
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Fax | 949-612-1690
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIAM RAZI
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Credential | M.D
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Telephone | 949-273-9247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A101725
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License Number State | CA
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