MEDICARE: COASTAL INFUSION, 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	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1417728726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL INFUSION, LLC

Provider Business Mailing Address
First Line	:	4331 N FEDERAL HWY STE 300
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5252
Country	:	US
Telephone Number	:	786-394-3063
Fax Number	:	954-361-8699

Provider Business Practice Location Address
First Line	:	4331 N FEDERAL HWY STE 300
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5252
Country	:	US
Telephone Number	:	954-361-1000
Fax Number	:	954-361-8699

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS DEVELOPMENT
Name	:	NICOLE BEGUIRISTAIN
Credential	:
Telephone Number	:	786-394-3063

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	02/20/2024

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Directions to “COASTAL INFUSION, LLC ” Practice Location

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