Organization
COASTAL WELLNESS CLINIC APC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHON WHEATON (ADMINISTRATIVE OFFICER)
(619) 782-0011
Entity
Organization
Contact information
Practice address
2373 JEFFERSON ST, CARLSBAD, CA 92008-1405
(619) 782-0011
Mailing address
2358 UNIVERSITY AVE STE 371, SAN DIEGO, CA 92104-2720
(619) 782-0011
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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