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Organization

PACIFIC COAST MEDICAL SUPPLY

Active
Other names
Gold Coast Diabetes
Organization subpart
No

Provider details

NPI number
Authorized official
CARIE MORTENSEN (CEO/PRESIDENT)
(562) 706-4552
Entity
Organization

Contact information

Practice address
1704 W MANCHESTER AVE, SUITE 105, LOS ANGELES, CA 90047-3063
(562) 706-4552
(877) 733-3462
Mailing address
218 CHICAGO AVE, SUITE 8, HUNTINGTON BEACH, CA 92648-5292
(562) 706-4552
(877) 733-3462

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CA

Other

Enumeration date
04/15/2015
Last updated
04/24/2015
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