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General NPI Number Information
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NPI Number | 1740311737
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Entity Type | Organization
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Legal Business Name | COASTAL KIDS, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 2071 SAN JOAQUIN HILLS RD
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-6505
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Country | US
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Telephone | 949-759-1720
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Fax | 949-759-1442
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Provider Business Mailing Address
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Address Line | 24422 AVENIDA DE LA CARLOTA STE 300
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3628
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Country | US
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Telephone | 949-599-2434
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Fax | 949-599-2430
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JEFFREY THOMPSON
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Credential |
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Telephone | 949-448-8821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A56395
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License Number State | CA
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