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General NPI Number Information
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NPI Number | 1699323873
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Entity Type | Organization
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Legal Business Name | COASTAL MOBILE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 10825 BASAL EDGE RD
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City | HELOTES
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State | TX
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Zip | 78023-5109
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Country | US
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Telephone | 210-867-9563
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Fax |
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Provider Business Mailing Address
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Address Line | 10825 BASAL EDGE RD
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City | HELOTES
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State | TX
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Zip | 78023-5109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | RON GUEVARA
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Credential | DO
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Telephone | 361-728-5907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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