# COASTAL ORTHOPEDICS & SPORTS MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043453640
- **Authorized official:** DR. RODMAN ST. CLAIR SR. M.D. (PRESIDENT)
- **Authorized official phone:** (909) 605-8000

## Contact information

- **Practice address:** 3998 VISTA WAY, SUITE B, OCEANSIDE, CA 92056-4514
- **Practice address phone:** (760) 724-5173
- **Mailing address:** 3998 VISTA WAY, SUITE B, OCEANSIDE, CA 92056-4514
- **Mailing address phone:** (760) 724-5173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 04/13/2009
- **Last updated:** 04/13/2009