Coastal Village Primary, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A49080 Issued in CA

Legal business name

COASTAL VILLAGE PRIMARY, INC

Practice address

2 James Way
Suite 209
Pismo Beach, CA 93449-4973

Phone

(805) 773-7440

Fax

(805) 773-7448

NPI assigned

Nov 28, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Joseph A Cruz, MD

Title

President/Owner

Phone

(805) 773-7440

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1354060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354060800000",
    "number": "1396080511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 JAMES WAY",
            "address_2": "SUITE 209",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934494973",
            "telephone_number": "805-773-7440",
            "fax_number": "805-773-7448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 JAMES WAY",
            "address_2": "SUITE 209",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934494973",
            "telephone_number": "805-773-7440",
            "fax_number": "805-773-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VILLAGE PRIMARY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-28",
        "last_updated": "2012-11-28",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "805-773-7440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A49080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Podiatry Inc
• Coastal Psychiatry Care Professional Nursing Corp
• Coastal Surgical Specialists, Inc.
• Coastal Village Primary Care
• Coastal Village Primary Care, a Medical Group
• Terrell Cohen, D.D.S.
• Kimen M Colgan, PA
• Byron N Collier, DPM
• Teresa Maria Cordeiro, ANP
• County of San Luis Obispo (Judkins Middle School)

• Family Medicine Physician in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.