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General NPI Number Information
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NPI Number | 1508728437
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Entity Type | Organization
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Legal Business Name | COASTLINE BEHAVIORAL, LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1250 PROSPECT ST STE O 1&2
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City | LA JOLLA
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State | CA
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Zip | 92037-3680
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Country | US
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Telephone | 858-414-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 4TH AVE STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92103-3119
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Country | US
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Telephone | 858-414-0371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEOMEL SORIANO
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Credential | PMHNP-C
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Telephone | 858-414-0371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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