Basic Information
| Provider Information | |||||||||
| NPI: | 1669429221 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COAST PLAZA DOCTORS HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COAST PLAZA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13100 STUDEBAKER RD | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906502531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628683751 | ||||||||
| FaxNumber: | 5628683198 | ||||||||
| Practice Location | |||||||||
| Address1: | 13100 STUDEBAKER RD | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906502531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628683751 | ||||||||
| FaxNumber: | 5628683198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 09/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | GARNER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | BOYD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5628683751 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000162 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HSP40219H | 05 | CA | MEDICAID | HSC30219H | 05 | CA | MEDICAID |