# PACIFIC COAST MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gold Coast Diabetes
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053707182
- **Authorized official:** CARIE MORTENSEN (CEO/PRESIDENT)
- **Authorized official phone:** (562) 706-4552

## Contact information

- **Practice address:** 1704 W MANCHESTER AVE, SUITE 105, LOS ANGELES, CA 90047-3063
- **Practice address phone:** (562) 706-4552
- **Practice address fax:** (877) 733-3462
- **Mailing address:** 218 CHICAGO AVE, SUITE 8, HUNTINGTON BEACH, CA 92648-5292
- **Mailing address phone:** (562) 706-4552
- **Mailing address fax:** (877) 733-3462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | CA | Yes |

## Other

- **Enumeration date:** 04/15/2015
- **Last updated:** 04/24/2015