COASTAL SPORTS AND WELLNESS, INC (NPI# 1982727293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982727293 |
| Entity Type | Organization |
| Organization Name | COASTAL SPORTS AND WELLNESS, INC |
| Other Organization Name | COASTAL SPORTS AND WELLNESS MEDICAL CENTER |
| Practice Address |
4010 Sorrento Valley Blvd Suite 300 San Diego CA 92121-1405 |
| Practice Telephone | 8586780300 |
| Practice Fax Number | 8586780915 |
| Mailing Telephone | 8586780300 |
| Mailing Fax Number | 8586780915 |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JOHN MICHAEL MARTINEZ (PRESIDENT) |
| Authorized Official Telephone | 8586780300 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Coastal Sports and Wellness Medical Center | Doing Business As Name - Organization |
| Street Address |
4010 SORRENTO VALLEY BLVD SUITE 300 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92121-1405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881798221 | Frederick Allen Richburg II | Family Medicine | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2006-09-07 |
| 1174911507 | Deborah Turquie Sacal | Dietitian, Registered | 4010 Sorrento Valley Blvd, 400, San Diego, CA 92121-1432 | 2015-01-08 |
| 1144537390 | Kirsten Roberts | Physical Therapist | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2010-09-09 |
| 1669608840 | Kevin Klatt | Massage Therapist | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2009-06-02 |
| 1972776920 | Ana Luisa Elizondo | Physical Therapist | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2008-04-10 |
| 1922288802 | Rebeccah Rhenae Rodriguez | Family Medicine | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2007-11-08 |
| 1225197114 | Danny Demby Norrdin | Physical Therapist | 4010 Sorrento Valley Blvd, Suite 300, San Diego, CA 92121-1432 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225644917 | Anna Hand | Physical Therapist | 5945 Pacific Center Blvd Bldg #510, San Diego, CA 92121 | 2020-09-18 |
| 1972138030 | Lamarr Joyner | Licensed Vocational Nurse | 5930 Conerstone Court West, Suite 300, San Diego, CA 92121 | 2020-03-10 |
| 1396383212 | La Jolla Professional Plastic Surgery | Plastic Surgery | 4510 Executive Dr. Suite 105, San Diego, CA 92121 | 2019-12-11 |
| 1841852472 | Unmanned Systems Operations Group | Air Carrier | 4655 Executive Dr., Suite 700, San Diego, CA 92121 | 2019-07-03 |
| 1861051922 | Grace Getchell | Behavior Technician | 3978 Sorrento Valley Blvd. #100, San Diego, CA 92121 | 2019-06-11 |
| 1720643299 | Megan Jean Bathen | Behavior Technician | Cortica Behavioral Inc., 7090 Miratech Dr., San Diego, CA 92121 | 2019-05-09 |
| 1346804366 | Daniel Melita | Massage Therapist | 11689 Sorrento Valley Rd Ste Q, San Diego, CA 92121 | 2019-04-25 |
| 1831674464 | Stepahnie Becerra | Behavior Technician | 3978 Sorrento Valley Blvd Suite 100, San Diego, CA 92121 | 2018-09-28 |
| 1265915466 | Ailyn Martinez | Behavior Technician | 3978 Sorrento Valley Bldv, 100, San Diego, CA 92121 | 2018-09-13 |
| 1790265163 | Genben Lifesciences Corporation | Public Health or Welfare | 6370 Lusk Blvd Ste F205, San Diego, CA 92121 | 2018-08-15 |
| Find all providers in zip 92121 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1326507591 | Shea Family Chiropractic Apc | Clinic/Center | 11770 Bernardo Plaza Ct Ste 351, San Diego, CA 92128-2426 | 2019-03-18 |
| 1205392172 | Bay Park Acupuncture, Inc. | Clinic/Center | 5080 Camino Del Arroyo, Ste. 129, San Diego, CA 92108-4100 | 2019-02-15 |
| 1922597624 | Hospital Cemesa Roatan Inc | Clinic/Center | 4025 Camino Del Rio S Ste 341, San Diego, CA 92108-4107 | 2018-05-08 |
| 1558876813 | South America Medical Network Inc | Clinic/Center | 4025 Camino Del Rio S Ste 330, San Diego, CA 92108-4107 | 2017-12-08 |
| 1871023515 | Abi P&o Inc | Clinic/Center | 6190 Fairmount Ave Ste A, San Diego, CA 92120-3428 | 2017-06-15 |
| 1548705908 | Free Flow Health Acupuncture | Clinic/Center | 4002 Park Blvd. Ste.e, San Diego, CA 92103 | 2016-12-21 |
| 1912452087 | Oria Health and Wellness | Clinic/Center | 16150 Big Springs Way, San Diego, CA 92127-2024 | 2016-08-18 |
| 1053707208 | Connecticut General Life Insurance Company | Clinic/Center | 8620 Spectrum Center Blvd, San Diego, CA 92123-1406 | 2015-04-14 |
| 1487042198 | Mina Habibian Dmd Phd Dental Corporation | Clinic/Center | 11385 Poway Rd Ste 103, San Diego, CA 92128-5600 | 2015-01-04 |
| Find all providers in SAN DIEGO | ||||
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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.