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Organization
COASTAL VILLAGE PRIMARY, INC
Active
Organization
COASTAL VILLAGE PRIMARY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH A CRUZ MD (PRESIDENT/OWNER)
(805) 773-7440
Entity
Organization
Contact information
Practice address
2 JAMES WAY, SUITE 209, PISMO BEACH, CA 93449-4973
(805) 773-7440
(805) 773-7448
Mailing address
2 JAMES WAY, SUITE 209, PISMO BEACH, CA 93449-4973
(805) 773-7440
(805) 773-7448
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A49080
CA
Other
Enumeration date
11/28/2012
Last updated
11/28/2012
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