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General NPI Number Information
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NPI Number | 1336319698
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Entity Type | Organization
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Legal Business Name | COASTAL PODIATRY CLINIC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 2 JAMES WAY SUITE 205
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City | PISMO BEACH
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State | CA
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Zip | 93449-4973
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Country | US
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Telephone | 805-773-3668
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Fax | 805-773-1043
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Provider Business Mailing Address
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Address Line | 2 JAMES WAY SUITE 205
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City | PISMO BEACH
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State | CA
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Zip | 93449-4973
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Country | US
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Telephone | 805-773-3668
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Fax | 805-773-1043
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | RICHARD JAY NORMAN
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Credential | DPM
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Telephone | 805-773-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | E4306
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License Number State | CA
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