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General NPI Number Information
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NPI Number | 1457533531
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Entity Type | Organization
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Legal Business Name | COASTAL ORTHOTIC AND PROSTHETIC SERVICES, INC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 2365 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-3216
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Country | US
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Telephone | 707-445-3111
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Fax | 707-442-8792
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Provider Business Mailing Address
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Address Line | 2365 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-3216
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Country | US
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Telephone | 707-445-3111
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Fax | 707-442-8792
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALFRED M QUINTANA
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Credential | CPO
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Telephone | 707-445-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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