| Organization Name: | COASTAL AESTHETIC CENTER PA |
| NPI Number: | 1114119393 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WINNIE VU (OFFICE MANAGER) |
| Mailing Address: | 301 Health Park Blvd Ste 109 Saint Augustine |
| State: | FL US |
| Postal Code: | 320865794 |
| Phone Number: | 9042451320 |
| Fax Number: | 8668782261 |
| NPI Enumeration Date: | 08/13/2007 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | ME99062 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |