Organization
COASTAL PEDIATRICS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI BOHANNAN (PRACTICE MANAGER)
(805) 983-3900
Entity
Organization
Contact information
Practice address
451 W GONZALES RD, STE 340, OXNARD, CA 93036-9004
(805) 983-3900
(805) 983-3887
Mailing address
451 W GONZALES RD, STE 340, OXNARD, CA 93036-9004
(805) 983-3900
(805) 983-3887
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ76023Z
—
CA
Enumeration date
02/22/2007
Last updated
08/22/2020
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