Provider Demographics
NPI:1235477498
Name:PACIFIC COAST OSTEOPATHY
Entity type:Organization
Organization Name:PACIFIC COAST OSTEOPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-792-8900
Mailing Address - Street 1:550 SILVER SPUR RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3612
Mailing Address - Country:US
Mailing Address - Phone:310-792-8900
Mailing Address - Fax:310-792-8907
Practice Address - Street 1:550 SILVER SPUR RD STE 240
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90275-3612
Practice Address - Country:US
Practice Address - Phone:310-792-8900
Practice Address - Fax:310-792-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty