Provider Demographics
NPI:1962807347
Name:COASTAL SPINE AND ORTHOPEDICS SPECIALIST, INC
Entity type:Organization
Organization Name:COASTAL SPINE AND ORTHOPEDICS SPECIALIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-933-7012
Mailing Address - Street 1:455 OLD NEWPORT BLVD
Mailing Address - Street 2:101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4241
Mailing Address - Country:US
Mailing Address - Phone:949-933-7012
Mailing Address - Fax:949-387-3380
Practice Address - Street 1:455 OLD NEWPORT BLVD
Practice Address - Street 2:101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4241
Practice Address - Country:US
Practice Address - Phone:949-933-7012
Practice Address - Fax:949-387-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty