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General NPI Number Information
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NPI Number | 1437436185
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Entity Type | Organization
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Legal Business Name | COAST PODIATRY GROUP OF SOLANA BEACH INC.
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 550 LOMAS SANTA FE DR SUITE B
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City | SOLANA BEACH
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State | CA
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Zip | 92075-1341
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Country | US
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Telephone | 858-755-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-474-9809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACK REINGOLD
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Credential | DPM
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Telephone | 858-755-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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