Provider Demographics
NPI:1902267644
Name:COASTAL CHILDREN'S SPECIALTY GROUP, INC.
Entity type:Organization
Organization Name:COASTAL CHILDREN'S SPECIALTY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TORIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-933-8750
Mailing Address - Street 1:2850 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1596
Mailing Address - Country:US
Mailing Address - Phone:562-933-8750
Mailing Address - Fax:562-933-8014
Practice Address - Street 1:2850 LONG BEACH BLVD
Practice Address - Street 2:SUITE 177
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1596
Practice Address - Country:US
Practice Address - Phone:562-933-8750
Practice Address - Fax:562-933-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty