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General NPI Number Information
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NPI Number | 1831199710
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Entity Type | Organization
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Legal Business Name | COASTAL PEDIATRICS LLC
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1275 W GRANADA BLVD STE 3A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8259
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Country | US
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Telephone | 386-672-1490
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Fax | 386-672-1682
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Provider Business Mailing Address
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Address Line | 1275 W GRANADA BLVD STE 3A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8259
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Country | US
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Telephone | 386-672-1490
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Fax | 386-672-1682
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN-CLAUDE JEANTY
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Credential | M.D.
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Telephone | 386-672-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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