Provider Demographics
NPI:1316612575
Name:COASTAL P&O LLC
Entity type:Organization
Organization Name:COASTAL P&O LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:714-614-5981
Mailing Address - Street 1:18 BUSHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0513
Mailing Address - Country:US
Mailing Address - Phone:714-614-5981
Mailing Address - Fax:
Practice Address - Street 1:26300 LA ALAMEDA STE 120
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6380
Practice Address - Country:US
Practice Address - Phone:714-614-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty