# COASTAL DIAGNOSTIC TESTING GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COASTAL DIAGNOSTIC TESTING GROUP INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134894009
- **Legal business name:** COASTAL DIAGNOSTIC TESTING GROUP INC
- **Authorized official:** MR. MEHRDAD GERAMI (PRESIDENT)
- **Authorized official phone:** (541) 756-7710

## Contact information

- **Practice address:** 615 CHETCO AVE, STE A, BROOKINGS, OR 97415
- **Practice address phone:** (541) 412-9556
- **Practice address fax:** (541) 756-7699
- **Mailing address:** 1957 THOMPSON RD, SUITE E, COOS BAY, OR 97420
- **Mailing address phone:** (541) 756-7710
- **Mailing address fax:** (541) 756-7699

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/12/2021
- **Last updated:** 09/06/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 500719439 | — | OR |