Provider Demographics
NPI:1548635915
Name:COASTAL SURGICAL PHYSICIAN-ASSISTANT PARTNERS
Entity type:Organization
Organization Name:COASTAL SURGICAL PHYSICIAN-ASSISTANT PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-549-3284
Mailing Address - Street 1:300 CARLSBAD VILLAGE DR
Mailing Address - Street 2:SUITE 108A #395
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2900
Mailing Address - Country:US
Mailing Address - Phone:619-549-3284
Mailing Address - Fax:760-637-5440
Practice Address - Street 1:300 CARLSBAD VILLAGE DR
Practice Address - Street 2:SUITE 108A #395
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2900
Practice Address - Country:US
Practice Address - Phone:619-549-3284
Practice Address - Fax:760-637-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A105472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG96448Medicare UPIN