Provider Demographics
NPI:1528065679
Name:COASTAL PATHOLOGY MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:COASTAL PATHOLOGY MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-441-4420
Mailing Address - Street 1:2425 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3218
Mailing Address - Country:US
Mailing Address - Phone:707-445-8121
Mailing Address - Fax:707-269-3782
Practice Address - Street 1:2425 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3218
Practice Address - Country:US
Practice Address - Phone:707-441-4420
Practice Address - Fax:707-269-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4779028Medicaid
CA=========OtherBLUE CROSS PROVIDER NUMBE
CAZZZ00768ZMedicare ID - Type UnspecifiedPROVIDER NUMBER