MEDICARE: BRIAN M COOMBE MEDICAL CORPORATION

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1962092957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN M COOMBE MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2900 QUEDADA
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3533
Country	:	US
Telephone Number	:	415-515-9279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 203
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3762
Country	:	US
Telephone Number	:	818-709-8161
Fax Number	:	818-709-8160

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN M COOMBE
Credential	:	MD
Telephone Number	:	412-515-9279

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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