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General NPI Number Information
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NPI Number | 1770576167
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Entity Type | Organization
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Legal Business Name | COASTLINE IMAGING LLC
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 2290 W EAU GALLIE BLVD STE 104
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City | MELBOURNE
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State | FL
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Zip | 32935-3134
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Country | US
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Telephone | 321-253-2700
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Fax | 321-253-2267
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Provider Business Mailing Address
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Address Line | 2290 W EAU GALLIE BLVD STE 104
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City | MELBOURNE
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State | FL
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Zip | 32935-3133
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Country | US
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Telephone | 321-253-2700
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Fax | 321-253-2267
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Authorized Official
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Title or Position | COMPLIANCE OFFICER
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Name | LAURA KASSA
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Credential |
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Telephone | 904-640-9129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | HCC3989
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | HCC3989
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License Number State | FL
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