NPIMap

Organization Active NPI

Coastal Health Alliance

  • Family Medicine Physician
  • Point Reyes Station, CA
National Provider Identifier
1699956839
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COASTAL HEALTH ALLIANCE
Practice address
65 Third Street, Suite 17
Point Reyes Station, CA 94956-0910
Phone
(415) 663-8781
Fax
(415) 663-9630
NPI assigned
Nov 15, 2007
Last updated
Feb 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

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

Authorized official

Name
Rafael Gomez
Title
Executive Director
Phone
(415) 663-8781

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X CA
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

65 Third Street, Suite 17
Point Reyes Station, CA 94956-0910

Mailing address

PO Box 910
65 Third Street, Suite 17
Point Reyes Station, CA 94956-0910
Phone (415) 663-8781

Other identifiers 1

IdentifierTypeStateIssuer
EAP70434FMedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298332800000",
    "number": "1699956839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "address_2": "65 THIRD STREET, SUITE 17",
            "city": "POINT REYES STATION",
            "state": "CA",
            "postal_code": "949560910",
            "telephone_number": "415-663-8781",
            "fax_number": "415-663-9630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 THIRD STREET, SUITE 17",
            "city": "POINT REYES STATION",
            "state": "CA",
            "postal_code": "949560910",
            "telephone_number": "415-663-8781",
            "fax_number": "415-663-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-15",
        "last_updated": "2011-02-22",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-663-8781"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP70434F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Point Reyes Station, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; 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.