Provider Demographics
NPI:1043453640
Name:COASTAL ORTHOPEDICS & SPORTS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:COASTAL ORTHOPEDICS & SPORTS MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. CLAIR
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:909-605-8000
Mailing Address - Street 1:3998 VISTA WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4514
Mailing Address - Country:US
Mailing Address - Phone:760-724-5173
Mailing Address - Fax:
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:SUITE B
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4514
Practice Address - Country:US
Practice Address - Phone:760-724-5173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty