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General NPI Number Information
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NPI Number | 1720183569
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Entity Type | Organization
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Legal Business Name | COASTAL CARDIOLOGY A MEDICAL CORP
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1941 JOHNSON AVE STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4154
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Country | US
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Telephone | 805-782-8844
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Fax | 813-613-2634
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Provider Business Mailing Address
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Address Line | PO BOX 12003
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406-2003
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Country | US
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Telephone | 805-782-8844
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Fax | 805-540-5881
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MARISSA FAMULARO
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Credential |
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Telephone | 805-782-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA23186
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | A63687
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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