MEDICARE: COAST NEPHROLOGY MEDICAL GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	BU94027460	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST NEPHROLOGY MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	3780 KILROY AIRPORT WAY
Second Line	:	STE 115
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2458
Country	:	US
Telephone Number	:	562-595-7426
Fax Number	:	562-989-3054

Provider Business Practice Location Address
First Line	:	3780 KILROY AIRPORT WAY
Second Line	:	STE 115
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2458
Country	:	US
Telephone Number	:	562-595-7426
Fax Number	:	562-989-3054

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN I ERLBAUM
Credential	:	M.D.
Telephone Number	:	562-595-7426

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/02/2007

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