Basic Information
| Provider Information | |||||||||
| NPI: | 1245643279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL DIAGNOSTIC SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 61327 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926026044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882688607 | ||||||||
| FaxNumber: | 9514617074 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 W LA VETA AVE STE 615 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882688607 | ||||||||
| FaxNumber: | 9514617074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2014 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | WONG | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8882688607 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography |
No ID Information.