Summit Coastal Living

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

C50412 Issued in CA

Legal business name

SUMMIT COASTAL LIVING

Practice address

165 E Wilson St # B
Costa Mesa, CA 92627-1564

Phone

(949) 689-8880

NPI assigned

Mar 29, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Keith B Randle

Title

President

Phone

(949) 689-8880

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1831552850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2028",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926591028",
            "telephone_number": "949-689-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 E WILSON ST # B",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271564",
            "telephone_number": "949-689-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT COASTAL LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "RANDLE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-689-8880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "C50412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. KAMBIZ KARIMI",
            "identifier": "C50412",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karly Lyn Sukut-Neppl, D.D.S.
• Paul Sullivan, PSY.D.
• Steven Mark Sultanoff, PH.D.
• Michaela Summers
• Terra Summers, L.AC.
• Reyna Sun
• Tao Te Sun, D.D.S.
• Sundine Center for Facial Aesthetics and Plastic Surgery Inc
• Sunflower Surgical Institute, LLC
• Olivia Christine Sung

• Substance Abuse Rehabilitation Facility in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.