MEDICARE: COASTAL ALLERGY CARE 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	174400000X	Specialist	A74064	CA
2	174400000X	Specialist	G34328	CA

General Provider Information

NPI Number	:	1720240872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL ALLERGY CARE INC

Provider Business Mailing Address
First Line	:	2412 N PONDEROSA DR STE B111
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-8989
Fax Number	:	805-987-2855

Provider Business Practice Location Address
First Line	:	2412 N PONDEROSA DR STE B111
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2379
Country	:	US
Telephone Number	:	805-482-8989
Fax Number	:	805-987-2855

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEWIS KANTER
Credential	:	MD
Telephone Number	:	805-482-8989

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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Directions to “COASTAL ALLERGY CARE INC ” Practice Location

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