# COAST PHYSICAL MEDICINE INC

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

## Provider details

- **NPI number:** 1154720373
- **Authorized official:** DR. MARC CUBEIRO M.D. (PRESIDENT)
- **Authorized official phone:** (714) 963-0955

## Contact information

- **Practice address:** 10956 WARNER AVE, FOUNTAIN VALLEY, CA 92708-3853
- **Practice address phone:** (714) 963-0955
- **Practice address fax:** (714) 963-5775
- **Mailing address:** 17931 EUCLID ST, FOUNTAIN VALLEY, CA 92708-5409
- **Mailing address phone:** (714) 963-0955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | CA | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2014
- **Last updated:** 08/19/2019