Coastal Pediatrics Medical Group

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

COASTAL PEDIATRICS MEDICAL GROUP

Practice address

451 W Gonzales Rd
Ste 340
Oxnard, CA 93036-9004

Phone

(805) 983-3900

Fax

(805) 983-3887

NPI assigned

Feb 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Bohannan

Title

Practice Manager

Phone

(805) 983-3900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Scott Blank

  • Pediatric Adolescent Medicine Physician
  • Oxnard, CA
  • NPI 1770678070
  NPD (past)
• Robert Fostakowsky, M.D.

  • Pediatric Adolescent Medicine Physician
  • Oxnard, CA
  • NPI 1558456996
  NPD (past)
• Heather F Nichols, M.D.

  • Pediatrics Physician
  • Ventura, CA
  • NPI 1346465796
  NPD (past)
• Benjamin T Pecht, M.D.

  • Pediatric Adolescent Medicine Physician
  • Oxnard, CA
  • NPI 1528153921
  NPD (past)

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528193109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 W GONZALES RD",
            "address_2": "STE 340",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930369004",
            "telephone_number": "805-983-3900",
            "fax_number": "805-983-3887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 W GONZALES RD",
            "address_2": "STE 340",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930369004",
            "telephone_number": "805-983-3900",
            "fax_number": "805-983-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRICS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOHANNAN",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "805-983-3900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ76023Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Coastal Health Care, a Medical Corporation
• Coastal Occupational Medical Group, Inc
• Coastal Pharmaceutica Services Corp (Herbay Pharmacy North/InfusionRx)
• Coastal Valley Communication Therapy Inc.
• Coastal Vascular Center PC (Coastal Vascular Center Inc.)
• Bianca Angelica Cobarruvias, MA, LMFT
• Cobbles Dialysis LLC (Channel Islands Dialysis)

• Pediatric Adolescent Medicine Physician in Oxnard, CA
• Providers in Oxnard, CA by specialty
• Pediatric Adolescent 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.