Organization
COASTAL PRESTIGE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNIE HAM MD (CEO)
(805) 416-2263
Entity
Organization
Contact information
Practice address
1677 SHELL BEACH RD, SHELL BEACH, CA 93449-1927
(805) 416-2263
(805) 201-9134
Mailing address
1677 SHELL BEACH RD, SHELL BEACH, CA 93449-1927
(805) 416-2263
(805) 201-9134
Taxonomy
Speciality
Code
Description
License number
State
103TF0000X
Family Psychologist
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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