Coastside Family Medical Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

COASTSIDE FAMILY MEDICAL CLINIC, INC

Practice address

225 Cabrillo Hwy S Ste 100a
Half Moon Bay, CA 94019-1738

Phone

(650) 712-7330

Fax

(650) 726-9317

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Robert V Harless

Title

Chief Executive Officer

Phone

(650) 712-7330

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508916628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CABRILLO HWY S STE 100A",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191738",
            "telephone_number": "650-712-7330",
            "fax_number": "650-726-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CABRILLO HWY S STE 100A",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191738",
            "telephone_number": "650-712-7330",
            "fax_number": "650-726-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTSIDE FAMILY MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HARLESS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "650-712-7330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70942F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Cai, DDS
• Emma Cho
• Coastal Wellness and Physical Therapy, Inc
• Coastpride, Inc.
• Coastside Adult Day Health Center
• Coastside Physical Therapy
• Irwin D Cohen, DPM
• William R Cohen
• Joseph R. Colella, CAADE/AOD INTERN
• Christy Erin Contreras, L.AC.

• Family Medicine Physician in Half Moon Bay, CA
• Providers in Half Moon Bay, 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 Aug 22, 2020; 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.