Provider Demographics
NPI:1306126560
Name:COASTAL CARE DME INC.
Entity type:Organization
Organization Name:COASTAL CARE DME INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NEZHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-855-2700
Mailing Address - Street 1:16530 VENTURA BLVD.
Mailing Address - Street 2:STE. 411
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-855-2700
Mailing Address - Fax:818-855-2701
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:STE. 411
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:818-855-2700
Practice Address - Fax:818-855-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies