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General NPI Number Information
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NPI Number | 1518832112
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Entity Type | Organization
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Legal Business Name | COASTAL MED LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 4400 W SAMPLE RD STE 244
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3473
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Country | US
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Telephone | 772-260-7326
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Fax |
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Provider Business Mailing Address
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Address Line | 3022 SW GRAPEVINE LN
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City | PALM CITY
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State | FL
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Zip | 34990-3254
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Country | US
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Telephone | 772-260-7326
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY SLONE LEGG
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Credential |
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Telephone | 772-260-7326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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