Provider Demographics
NPI:1528787660
Name:GOLDEN COAST AESTHETIC AND CONCIERGE MEDICINE CORP
Entity type:Organization
Organization Name:GOLDEN COAST AESTHETIC AND CONCIERGE MEDICINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GHALIB
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:WAHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-529-2330
Mailing Address - Street 1:881 DOVER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6900
Mailing Address - Country:US
Mailing Address - Phone:949-529-2330
Mailing Address - Fax:866-800-5276
Practice Address - Street 1:881 DOVER DR STE 250
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6900
Practice Address - Country:US
Practice Address - Phone:949-529-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty