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General NPI Number Information
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NPI Number | 1437013414
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Entity Type | Organization
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Legal Business Name | COASTAL WELLNESS LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 10840 WARNER AVE STE 102A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3847
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Country | US
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Telephone | 909-714-3672
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Fax |
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Provider Business Mailing Address
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Address Line | 10840 WARNER AVE STE 102A
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3847
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Country | US
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Telephone | 909-714-3672
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KHOI NGO
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Credential |
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Telephone | 909-714-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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