Organization
COASTSIDE FAMILY MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT V HARLESS (CHIEF EXECUTIVE OFFICER)
(650) 712-7330
Entity
Organization
Contact information
Practice address
225 CABRILLO HWY S STE 100A, HALF MOON BAY, CA 94019-1738
(650) 712-7330
(650) 726-9317
Mailing address
225 CABRILLO HWY S STE 100A, HALF MOON BAY, CA 94019-1738
(650) 712-7330
(650) 726-9317
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70942F
—
CA
Enumeration date
01/11/2007
Last updated
08/22/2020
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