# COASTAL SKIN AND EYE INSTITUTE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COASTAL SKIN & EYE INSTITUTE, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083273684
- **Legal business name:** COASTAL SKIN & EYE INSTITUTE, INC.
- **Authorized official:** MS. JEANNENE GRAHAM (PRACTICE MANAGER)
- **Authorized official phone:** (858) 943-2540

## Contact information

- **Practice address:** 477 N EL CAMINO REAL STE C300, ENCINITAS, CA 92024-1356
- **Practice address phone:** (760) 257-5550
- **Practice address fax:** (858) 252-2053
- **Mailing address:** 5550 CARMEL MOUNTAIN RD STE 206, SAN DIEGO, CA 92130-4861
- **Mailing address phone:** (858) 943-2540
- **Mailing address fax:** (858) 252-2053

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/07/2019
- **Last updated:** 08/13/2025