Organization
COASTAL HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL GOMEZ (EXECUTIVE DIRECTOR)
(415) 663-8781
Entity
Organization
Contact information
Practice address
65 THIRD STREET, SUITE 17, POINT REYES STATION, CA 94956-0910
(415) 663-8781
(415) 663-9630
Mailing address
PO BOX 910, 65 THIRD STREET, SUITE 17, POINT REYES STATION, CA 94956-0910
(415) 663-8781
(415) 663-9630
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP70434F
—
CA
Enumeration date
11/15/2007
Last updated
02/22/2011
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