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General NPI Number Information
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NPI Number | 1326109604
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Entity Type | Organization
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Legal Business Name | COASTAL CENTER FOR OBESITY
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1094 W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-2928
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Country | US
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Telephone | 310-833-4448
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Fax | 310-833-1146
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Provider Business Mailing Address
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Address Line | 1094 W. 7TH STREET
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City | SAN PEDRO
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State | CA
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Zip | 90731-2928
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Country | US
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Telephone | 310-833-4448
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Fax | 310-833-1146
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Authorized Official
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Title or Position | PHYSICIAN AND SURGEON
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Name | DR. MILTON L. OWENS
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Credential | M.D.
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Telephone | 310-833-4448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | I-107334-L
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License Number State | CA
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