# PACIFIC COAST MEDICAL SUPPLY, LLC

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

## Provider details

- **NPI number:** 1801268628
- **Authorized official:** MS. CARIE MORTENSEN (CEO/PRESIDENT)
- **Authorized official phone:** (562) 706-4552

## Contact information

- **Practice address:** 1155 SPORTFISHER DR, SUITE 210, OCEANSIDE, CA 92054-4168
- **Practice address phone:** (562) 706-4552
- **Practice address fax:** (877) 733-3462
- **Mailing address:** 1155 SPORTFISHER DR, SUITE 210, OCEANSIDE, CA 92054-4168
- **Mailing address phone:** (562) 706-4552
- **Mailing address fax:** (877) 733-3462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | CA | Yes |

## Other

- **Enumeration date:** 10/21/2015
- **Last updated:** 10/21/2015