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General NPI Number Information
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NPI Number | 1508049198
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Entity Type | Organization
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Legal Business Name | COASTAL ANESTHESIA ., INC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 3884 JEFFERSON BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-1606
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Country | US
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Telephone | 757-460-0249
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Fax | 757-460-0249
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Provider Business Mailing Address
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Address Line | 3884 JEFFERSON BLVD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-1606
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Country | US
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Telephone | 757-460-0249
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Fax | 757-460-0249
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | PAUL WERBIN
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Credential | CRNA
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Telephone | 757-460-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0001090514
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License Number State | VA
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