Coastal Psychiatry Care Professional Nursing Corp

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

COASTAL PSYCHIATRY CARE PROFESSIONAL NURSING CORP

Practice address

128 La Colima
Pismo Beach, CA 93449

Phone

(805) 608-5310

NPI assigned

Aug 3, 2026

Organization subpart

No

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

Authorized official

Name

Anna Hadilaksono

Title

Owner

Phone

(805) 608-5310

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1785715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1336062777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 FIVE CITIES DR STE 418",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493005",
            "telephone_number": "805-608-5310",
            "fax_number": "805-254-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 LA COLIMA",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "93449",
            "telephone_number": "805-608-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PSYCHIATRY CARE PROFESSIONAL NURSING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-03",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "HADILAKSONO",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-608-5310"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Terrell Cohen, D.D.S.

• Psychiatric/Mental Health Nurse Practitioner in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; 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.