Basic Information
| Provider Information | |||||||||
| NPI: | 1164471116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL CHILDREN'S CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3435 S ALAMEDA ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618557346 | ||||||||
| FaxNumber: | 3618554201 | ||||||||
| Practice Location | |||||||||
| Address1: | 3435 S ALAMEDA ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784111728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618557346 | ||||||||
| FaxNumber: | 3618554201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSHMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3618557346 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.