MEDICARE: RENEWMD COASTAL, 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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G73008	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1811372600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWMD COASTAL, INC.

Provider Business Mailing Address
First Line	:	6260 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-476-2953
Fax Number	:

Provider Business Practice Location Address
First Line	:	6260 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-476-2953
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SHARON SLOWIK
Credential	:	M.D.
Telephone Number	:	760-803-2253

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	11/26/2019

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Directions to “RENEWMD COASTAL, INC. ” Practice Location

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