Organization
COASTAL VEIN AND COSMETIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN TERESA SONG M.D. (PRESIDENT)
(714) 904-5594
Entity
Organization
Contact information
Practice address
62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
(949) 701-3394
(949) 748-8868
Mailing address
62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
(949) 701-3394
(949) 748-8868
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
A86825
CA
Other
Enumeration date
01/03/2009
Last updated
01/03/2009
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