Coastal Sports and Wellness, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

COASTAL SPORTS AND WELLNESS, INC

Practice address

4010 Sorrento Valley Blvd
Suite 300
San Diego, CA 92121-1405

Phone

(858) 678-0300

Fax

(858) 678-0915

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John Michael Martinez, M.D.

Title

President

Phone

(858) 678-0300

Specialties & licenses 1

Addresses

Other names 1

• Coastal Sports and Wellness Medical Center Doing business as

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982727293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 SORRENTO VALLEY BLVD",
            "address_2": "SUITE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211405",
            "telephone_number": "858-678-0300",
            "fax_number": "858-678-0915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 SORRENTO VALLEY BLVD",
            "address_2": "SUITE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211405",
            "telephone_number": "858-678-0300",
            "fax_number": "858-678-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SPORTS AND WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-678-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Sports and Wellness Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Coastal Sleep Solutions San Diego, Inc.
• Coastal Speech Therapy Inc
• Coastal Therapy Associates, Inc.
• Coastal Wellness Services, LLC
• Coastline Behavioral, LLC
• Amanda Georgianna Coates
• Natalie Ann Coates, MA

• Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinic/Center 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.