Organization
COASTAL PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN-CLAUDE JEANTY M.D. (OWNER)
(386) 672-1490
Entity
Organization
Contact information
Practice address
1275 W GRANADA BLVD, STE 3A, ORMOND BEACH, FL 32174-8259
(386) 672-1490
(386) 672-1682
Mailing address
1275 W GRANADA BLVD, STE 3A, ORMOND BEACH, FL 32174-8259
(386) 672-1490
(386) 672-1682
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1202000
UNITED HEALTH CARE MEDICA
FL
01
—
26333
BLUE CROSS
FL
01
—
5907098
AETNA
FL
01
—
6633914-001
CIGNA
FL
01
—
759373
CONNECTICARE
FL
01
—
761792
FIRST HEALTH
FL
01
—
F95182
FLORIDA HOSPITAL
FL
Enumeration date
07/21/2005
Last updated
08/22/2020
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