NPIMap

Organization Active NPI

Pacific Coast Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • Los Angeles, CA
National Provider Identifier
1053707182
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PACIFIC COAST MEDICAL SUPPLY
Practice address
1704 W Manchester Ave
Suite 105
Los Angeles, CA 90047-3063
Phone
(562) 706-4552
Fax
(877) 733-3462
NPI assigned
Apr 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carie Mortensen
Title
Ceo/President
Phone
(562) 706-4552

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X CA Primary

Addresses

Primary practice location

1704 W Manchester Ave
Suite 105
Los Angeles, CA 90047-3063

Mailing address

218 Chicago Ave
Suite 8
Huntington Beach, CA 92648-5292
Phone (562) 706-4552

Other names 1

  • Gold Coast Diabetes Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Gold Coast Diabetes3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1053707182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 CHICAGO AVE",
            "address_2": "SUITE 8",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926485292",
            "telephone_number": "562-706-4552",
            "fax_number": "877-733-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W MANCHESTER AVE",
            "address_2": "SUITE 105",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900473063",
            "telephone_number": "562-706-4552",
            "fax_number": "877-733-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC COAST MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-15",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "MORTENSEN",
        "authorized_official_first_name": "CARIE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "562-706-4552"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gold Coast Diabetes",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.