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General NPI Number Information
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NPI Number | 1588086136
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Entity Type | Organization
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Legal Business Name | COASTAL MATERNITY CARE, INC.
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 450 DONDEE ST STE 5
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City | PACIFICA
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State | CA
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Zip | 94044-3258
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Country | US
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Telephone | 415-649-6262
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Fax | 415-649-6262
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Provider Business Mailing Address
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Address Line | PO BOX 743
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City | PACIFICA
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State | CA
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Zip | 94044-0743
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Country | US
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Telephone | 415-649-6262
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Fax | 415-649-6262
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Authorized Official
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Title or Position | OWNER, MIDWIFE, LACTATION CONSULTAN
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Name | SHARON ECONOMIDES
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Credential | LM, CPM, IBCLC
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Telephone | 415-649-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L10992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 225
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License Number State | CA
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