Organization
COASTAL PRESTIGE MEDICAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNIE ALAN HAM MD (CEO)
(805) 201-9135
Entity
Organization
Contact information
Practice address
1677 SHELL BEACH RD, SHELL BEACH, CA 93449-1927
(805) 201-9135
(805) 201-9134
Mailing address
1677 SHELL BEACH RD, SHELL BEACH, CA 93449-1927
(805) 201-9135
(805) 201-9134
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A90443
CA
Other
Enumeration date
04/28/2009
Last updated
03/12/2020
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