# PACIFIC COAST SPORTS MEDICINE

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

## Provider details

- **NPI number:** 1083985451
- **Authorized official:** DR. WALTER OBRIEN (PRESIDENT)
- **Authorized official phone:** (310) 477-7276

## Contact information

- **Practice address:** 11600 WILSHIRE BLVD, SUITE 522, LOS ANGELES, CA 90025-5781
- **Practice address phone:** (310) 477-7276
- **Practice address fax:** (310) 477-5148
- **Mailing address:** 11600 WILSHIRE BLVD, SUITE 522, LOS ANGELES, CA 90025-5781
- **Mailing address phone:** (310) 477-7276
- **Mailing address fax:** (310) 477-5148

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | NULL | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225700000X | Massage Therapist | — | NULL | — |
| 225700000X | Massage Therapist | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 01/18/2012
- **Last updated:** 01/18/2012