# COASTAL MOBILE MEDICAL GROUP, PLLC

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

## Provider details

- **NPI number:** 1699323873
- **Authorized official:** RON GUEVARA DO (PRESIDENT/OWNER)
- **Authorized official phone:** (361) 728-5907

## Contact information

- **Practice address:** 10825 BASAL EDGE RD, HELOTES, TX 78023-5109
- **Practice address phone:** (210) 867-9563
- **Mailing address:** 10825 BASAL EDGE RD, HELOTES, TX 78023-5109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2019
- **Last updated:** 08/30/2019