Coastal Medical and Cosmetic Dermatology Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A88738 Issued in CA

Legal business name

COASTAL MEDICAL AND COSMETIC DERMATOLOGY INC

Practice address

9850 Genesee Ave Ste 500
La Jolla, CA 92037-1213

Phone

(858) 657-0267

NPI assigned

Feb 3, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Darrell Wayne Gonzales, M.D.NPI 1417960188

Title

Owner, President, Cfo

Phone

(858) 657-0267

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darrell Wayne Gonzales, M.D.

  • Dermatology Physician
  • La Jolla, CA
  • NPI 1417960188
  Medicare reassignment Care Compare group Authorized official
• Timothy W Chang, MD

  • MOHS-Micrographic Surgery Physician
  • La Jolla, CA
  • NPI 1962766337

  Dermatology

  Medicare reassignment Care Compare group NPD
• Alyssa A Nash Goelitz, M.D.

  • Dermatology Physician
  • La Jolla, CA
  • NPI 1518064641
  Medicare reassignment Care Compare group
• Joyce Cheng, MD, MHS

  • Dermatology Physician
  • La Jolla, CA
  • NPI 1144753468
  NPD
• Minh-Tuan Richard Hoang, M.D.

  • Procedural Dermatology Physician
  • Port Orchard, WA
  • NPI 1699716860
  NPD (past)
• Alizabeth Lechi Truong, MD

  • Dermatology Physician
  • Port Orchard, WA
  • NPI 1801898598
  NPD (past)

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

{
    "created_epoch": "1233619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1346488004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 850",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371213",
            "telephone_number": "858-657-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 500",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371213",
            "telephone_number": "858-657-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL AND COSMETIC DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-03",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER, PRESIDENT, CFO",
        "authorized_official_telephone_number": "858-657-0267",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A88738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1417960188",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cloisters of la Jolla Inc (Shea Family Care La Jolla)
• Katelyn Cloyd, ND
• CMX Capital, LLC (Vavici Health Solutions)
• Coast Urology Medical Group, Inc
• Coastal ENT Medical Group Inc (Coastal ENT Medical Group)
• Coastal Neurological Medical Group
• Gavin Drew Cobb, DO
• Marjorie Coburn, PH.D.
• Alvin Bob Coda, M.D.
• Daniel J Coden, MD

• Dermatology Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.