Provider Demographics
NPI:1588086136
Name:COASTAL MATERNITY CARE, INC.
Entity type:Organization
Organization Name:COASTAL MATERNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MIDWIFE, LACTATION CONSULTAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ECONOMIDES
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM, IBCLC
Authorized Official - Phone:415-649-6262
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-0743
Mailing Address - Country:US
Mailing Address - Phone:415-649-6262
Mailing Address - Fax:415-649-6262
Practice Address - Street 1:450 DONDEE ST STE 5
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3258
Practice Address - Country:US
Practice Address - Phone:415-649-6262
Practice Address - Fax:415-649-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL10992174N00000X
CA225176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty