Coastal Village Primary Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A49080 Issued in CA

Legal business name

COASTAL VILLAGE PRIMARY CARE

Practice address

2 James Way
Suite 209
Pismo Beach, CA 93449-4976

Phone

(805) 773-7440

Fax

(805) 773-7448

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Joseph A. Cruz, MD

Title

General Partner

Phone

(805) 773-7440

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven E Barbere, FNP

  • Family Nurse Practitioner
  • San Luis Obispo, CA
  • NPI 1568487908
  NPD (past)
• Karen Ann Fong, MD

  • Internal Medicine Physician
  • San Luis Obispo, CA
  • NPI 1851396816
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1992738496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "GROVER BEACH",
            "state": "CA",
            "postal_code": "934830428",
            "telephone_number": "805-773-7440",
            "fax_number": "805-773-7448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 JAMES WAY",
            "address_2": "SUITE 209",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934494976",
            "telephone_number": "805-773-7440",
            "fax_number": "805-773-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VILLAGE PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "805-773-7440",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A49080",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A70251",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ06670Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher V Lutman MD a California Medical Corporation
• Coastal Podiatry Clinic
• Coastal Podiatry Inc
• Coastal Psychiatry Care Professional Nursing Corp
• Coastal Surgical Specialists, Inc.
• Coastal Village Primary Care, a Medical Group
• Coastal Village Primary, Inc
• Terrell Cohen, D.D.S.
• Kimen M Colgan, PA
• Byron N Collier, DPM

• Family Medicine Physician in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.