# PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Coastal Orthopaedics & Sports Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073590105
- **Authorized official:** MRS. JEANNETTE BRODY (BILLING MANAGER)
- **Authorized official phone:** (760) 724-1033

## Contact information

- **Practice address:** 3998 VISTA WAY, SUITE B, OCEANSIDE, CA 92056-4500
- **Practice address phone:** (760) 724-5173
- **Practice address fax:** (760) 724-5265
- **Mailing address:** 3998 VISTA WAY, SUITE B, OCEANSIDE, CA 92056-4500
- **Mailing address phone:** (760) 724-5173
- **Mailing address fax:** (760) 724-5265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | A47884 | CA | — |
| 207X00000X | Orthopaedic Surgery Physician | A70831 | CA | Yes |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | A70831 | CA | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | A68137 | CA | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | E4564 | CA | — |
| 363A00000X | Physician Assistant | PA17120 | CA | — |

## Other

- **Enumeration date:** 12/29/2005
- **Last updated:** 07/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0089840 | — | CA |