Provider Demographics
NPI:1336917061
Name:COASTAL SERENITY PSYCHIATRY A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:COASTAL SERENITY PSYCHIATRY A PROFESSIONAL NURSING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:760-884-4729
Mailing Address - Street 1:13163 RUSSET LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2377
Mailing Address - Country:US
Mailing Address - Phone:269-615-1147
Mailing Address - Fax:
Practice Address - Street 1:11440 W BERNARDO CT STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1644
Practice Address - Country:US
Practice Address - Phone:760-884-4729
Practice Address - Fax:269-210-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty