Active NPI
Nicole Gabriele Coufal, M.D.
- Pediatric Critical Care Medicine Physician
- San Diego, CA
National Provider Identifier
1790079655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- A124395
- Practice address
- 3020 Childrens Way
San Diego, CA 92123-4223 - Phone
- (858) 576-1700
- NPI assigned
- Jun 7, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | A124395 | CA | Primary |
| Pediatrics Physician | 208000000X | A124395 | CA |
Addresses
Primary practice location
3020 Childrens Way
San Diego, CA 92123-4223
Mailing address
3020 Childrens Way
Mc5003
San Diego, CA 92123-4223
Phone (858) 576-1700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A124395 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Service Medical Group | Pediatric Critical Care Medicine | Current | Accepting new patients |
Locations
3626 Ruffin Rd
San Diego, CA 92123
Phone (619) 565-9666
Interoperability endpoints
- ncoufal63847@radychildrens.direct-ci.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- San Diego, CA
- NPI 1669617197
-
- Anesthesiology Physician
- San Diego, CA
- NPI 1053354233
Pediatric Critical Care Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771891200000",
"number": "1790079655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY",
"address_2": "MC5003",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-576-1700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-576-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COUFAL",
"first_name": "NICOLE",
"middle_name": "GABRIELE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-07",
"last_updated": "2026-02-24",
"certification_date": "2026-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "CA",
"license": "A124395",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A124395",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.