COASTAL FAMILY DERMATOLOGY, PC (NPI# 1174927073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174927073 |
| Entity Type | Organization |
| Organization Name | COASTAL FAMILY DERMATOLOGY, PC |
| Practice Address |
990 Pacific St San Luis Obispo CA 93401-6309 |
| Practice Telephone | 8055545567 |
| Practice Fax Number | 8055443265 |
| Mailing Telephone | 8055445567 |
| Mailing Fax Number | 8055443265 |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2015-01-02 |
| Authorized Official Name | CHRISTINE DENISE KILCLINE (M.D./OWNER) |
| Authorized Official Telephone | 8055445567 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
A72400 | CA | Allopathic & Osteopathic Physicians |
| Y | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
A72400 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295290567 | Coastal Family Dermatology, PC | Dermatology | 892 Aerovista Pl Ste 120, San Luis Obispo, CA 93401-8054 | 2019-01-31 |
| Street Address |
990 PACIFIC ST |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93401-6309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053389247 | James Lee Longabaugh | Dermatology | 990 Pacific St, San Luis Obispo, CA 93401-6309 | 2006-03-14 |
| 1083197354 | Natalie Matenaer | Physician Assistant | 990 Pacific St, San Luis Obispo, CA 93401-6309 | 2018-09-12 |
| 1063781557 | Lisa Lindvall Aquino | Dermatology | 990 Pacific St, San Luis Obispo, CA 93401-6309 | 2011-12-29 |
| 1093724791 | Christine Denise Kilcline | Dermatology | 990 Pacific St, San Luis Obispo, CA 93401-6309 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497228399 | Barbara Jean Morrow | Dental Hygienist | 2191 Johnson Avenue, San Luis Obispo, CA 93401 | 2019-01-03 |
| 1104307743 | Griffith Jennings | Counselor | 1225 Kendal Rd, San Luis Obispo, CA 93401 | 2018-08-22 |
| 1124518808 | Joy L Delaluna | Licensed Psychiatric Technician | 692 Evens Rd, San Luis Obispo, CA 93401 | 2018-05-17 |
| 1982192084 | Sierra Mental Wellness Group | Community/Behavioral Health | 2180 B Johnson Avenue, San Luis Obispo, CA 93401 | 2018-04-25 |
| 1326554403 | Veronica Chanel Laguna | Case Manager/Care Coordinator | 1065 Kansas Ave., San Luis Obispo, CA 93401 | 2017-12-27 |
| 1043739782 | Janette Lynn Branca | Case Manager/Care Coordinator | 285 South Street, Suit J, San Louis Obispo, CA 93401 | 2017-09-13 |
| 1588194104 | Adv Vision LLC | Optometrist | 835 Aero Vista Pl, #110, San Luis Obispo, CA 93401 | 2017-06-15 |
| 1508395880 | Samantha Clay | Counselor | 1255 Kendall Road, San Luis Obispo, CA 93401 | 2017-06-08 |
| 1659804771 | Sara Anne Powers | Counselor | 697 Higuera Street D, San Luis Obispo, CA 93401 | 2017-04-05 |
| 1508306010 | Russell Piazza | Pharmacist | 873 Ricardo Court, San Luis Obispo, CA 93401 | 2017-03-02 |
| Find all providers in zip 93401 | ||||
| Taxonomy Code | 207NP0225X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Pediatric Dermatology |
| A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: changed definition, added source] Additional Resources: American Board of Dermatology, 2007, http://www.abderm.org/ A subspecialty certificate was approved by ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295290567 | Coastal Family Dermatology, PC | Dermatology | 892 Aerovista Pl Ste 120, San Luis Obispo, CA 93401-8054 | 2019-01-31 |
| 1093724791 | Christine Denise Kilcline | Dermatology | 990 Pacific St, San Luis Obispo, CA 93401-6309 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700371275 | Icecreamwala Dermatology Inc | Dermatology | 2435 Webster St Ste 101, Berkeley, CA 94705 | 2018-06-27 |
| 1881989325 | Heather Irina Rishel | Dermatology | 345 W Portal Ave Ste 320, San Francisco, CA 94127-1429 | 2011-06-13 |
| 1396984423 | Marcia J Glenn Md & Associates Dermatology & Laser Med Ctr Inc | Dermatology | 4644 Lincoln Blvd Ste 500, Marina Del Rey, CA 90292-6391 | 2009-02-12 |
| 1528259744 | Phuong Khuu | Dermatology | 900 Blake Wilbur Dr Rm W0069, Stanford, CA 94305 | 2007-08-05 |
| 1932195567 | Neil Frank Gibbs | Dermatology | 34520 Bob Wilson Dr, Dermatology Department, Naval Medical Center, San Diego, CA 92134-2300 | 2005-09-20 |
| 1467811653 | Valley Children's Medical Group - Dept of Dermatology | Dermatology | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2016-02-16 |
| 1447620539 | Valley Children's Specialty Medical Group - Dept of Dermatology | Dermatology | 9300 Valley Childrens Pl, Madera, CA 93636-8761 | 2015-10-01 |
| 1437594884 | Jessica Sprague | Dermatology | 8010 Frost St Ste 602, San Diego, CA 92123 | 2013-04-29 |
| 1366725590 | Pediatric Dermatology of Orange County PC | Dermatology | 3500 Barranca Pkwy, Ste 160, Irvine, CA 92606-8226 | 2011-09-23 |
| 1245479385 | Dong L Chang M D | Dermatology | 100 N Santa Anita Ave, Arcadia, CA 91006-3108 | 2009-02-12 |
| Find all providers with the same taxonomy | ||||
| City | SAN LUIS OBISPO |
| Zip Code | 93401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.