=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467383075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL CONNECTION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2026
-----------------------------------------------------
Last Update Date | 05/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28562 OSO PKWY # D-313
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-5595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-533-3046
-----------------------------------------------------
Fax | 949-288-6231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28562 OSO PKWY # D-313
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-5595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-533-3046
-----------------------------------------------------
Fax | 949-288-6231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MICHAEL VILLARREAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-533-3046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------