MEDICARE: COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	080000519	CA

General Provider Information

NPI Number	:	1386748440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST CENTER FOR ORTHOPEDIC AND ARTHROSCOPIC SURGERY LLC

Provider Business Mailing Address
First Line	:	5643 COPLEY DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7903
Country	:	US
Telephone Number	:	858-268-3566
Fax Number	:	858-268-0430

Provider Business Practice Location Address
First Line	:	5643 COPLEY DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7903
Country	:	US
Telephone Number	:	858-268-3566
Fax Number	:	858-268-0430

Authorized Official
Title or Position	:	REGIONAL ADMINISTRATOR
Name	:	MRS. STACY PENA
Credential	:
Telephone Number	:	858-268-3566

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	12/19/2025

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