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General NPI Number Information
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NPI Number | 1932076635
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Entity Type | Organization
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Legal Business Name | COASTLINE SURGERY CENTER OF CALIFORNIA PC
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 2200 PACIFIC COAST HWY STE 215
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2701
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Country | US
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Telephone | 424-332-1574
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PACIFIC COAST HWY STE 215
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHELSEA FIDAI
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Credential | MD
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Telephone | 424-332-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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