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General NPI Number Information
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NPI Number | 1891289625
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Entity Type | Organization
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Legal Business Name | COAST PAIN MANAGEMENT, PC
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 111 N SEPULVEDA BLVD STE 210
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6849
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Country | US
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Telephone | 310-698-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N SEPULVEDA BLVD STE 210
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6849
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Country | US
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Telephone | 310-698-5451
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRV EDWARDS
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Credential | MD
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Telephone | 310-698-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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