Provider Demographics
NPI:1679562201
Name:COASTAL HOSPITALIST MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:COASTAL HOSPITALIST MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-682-6040
Mailing Address - Street 1:5050 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4381
Mailing Address - Country:US
Mailing Address - Phone:760-439-6581
Mailing Address - Fax:760-439-6585
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-439-6581
Practice Address - Fax:760-769-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098700Medicaid
CAGR0098700Medicaid
CAW15288Medicare PIN