COASTAL PRESTIGE MEDICAL SERVICES, INC (NPI# 1518101989) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518101989 |
| Entity Type | Organization |
| Organization Name | COASTAL PRESTIGE MEDICAL SERVICES, INC |
| Practice Address |
1677 Shell Beach Rd Shell Beach CA 93449-1927 |
| Practice Telephone | 8052019135 |
| Practice Fax Number | 8052019134 |
| Mailing Telephone | 8052019135 |
| Mailing Fax Number | 8052019134 |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2020-03-12 |
| Authorized Official Name | DR. JOHNNIE ALAN HAM (CEO) |
| Authorized Official Telephone | 8052019135 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
A90443 | CA | Ambulatory Health Care Facilities |
| Street Address |
1677 SHELL BEACH RD |
| City | SHELL BEACH |
| State | CA |
| Zip Code | 93449-1927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254413 | Coastal Prestige Clinic | Psychologist | 1677 Shell Beach Rd, Shell Beach, CA 93449-1927 | 2020-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831688795 | Kristyn Collins | Psychologist | 130 James Way, #150, Pismo Beach, CA 93449 | 2018-05-07 |
| 1245750140 | Judy Burke Morabito | Pedorthist | 801 Dolliver Street, Pismo Beach, CA 93449 | 2017-06-21 |
| 1295274413 | The San Luis Obispo Hearing Center, Inc | Specialist | 901 Oak Park Blvd Suite 202, Pismo Beach, CA 93449 | 2017-02-21 |
| 1649713645 | Sarah Victoria Stroemel | Counselor | 172 Stimson Ave, #3, Pismo Beach, CA 93449 | 2016-11-22 |
| 1497133631 | Byron N Collier | Podiatrist | 911 Oak Park Blvd Ste 106, Pismo Beach, CA 93449 | 2015-05-07 |
| 1982973319 | Mariana Dintyala | Nurse Practitioner | Avery Healthcare Sevices, 230 Coral Ct, Pismo Beach, CA 93449 | 2011-12-13 |
| 1538444575 | Chelsea Hunter | Student in an Organized Health Care Education/Training Program | 448 Foothill Rd, Pismo Beach, CA 93449 | 2011-10-20 |
| 1952621492 | Briana Leigh Schiro | Counselor | 314 El Portal Dr., Suite 100, Pismo Beach, CA 93449 | 2010-06-07 |
| 1134365315 | Robert Lee Hix | Licensed Psychiatric Technician | 201 Five Cities Dr., 123, Pismo Beach, CA 93449 | 2008-12-18 |
| 1689886764 | Active Physical Therapy Inc | Physical Therapist | 1851 Shell Beach Rd, Suite B, Shell Beach, CA 93449 | 2007-05-03 |
| Find all providers in zip 93449 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | SHELL BEACH |
| Zip Code | 93449 |
Please comment or provide details below to improve the information on COASTAL PRESTIGE MEDICAL SERVICES, INC.
| 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.