Organization
COASTAL VILLAGE PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH A. CRUZ MD (GENERAL PARTNER)
(805) 773-7440
Entity
Organization
Contact information
Practice address
2 JAMES WAY, SUITE 209, PISMO BEACH, CA 93449-4976
(805) 773-7440
(805) 773-7448
Mailing address
PO BOX 428, GROVER BEACH, CA 93483-0428
(805) 773-7440
(805) 773-7448
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A49080
CA
207R00000X
Internal Medicine Physician
A70251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ06670Z
BLUE SHIELD
CA
Enumeration date
07/08/2006
Last updated
09/16/2011
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