| Organization Name: | COAST FAMILY CARE LLC |
| NPI Number: | 1396010120 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENIS A VILCHEZ (MANAGER) |
| Mailing Address: | 4100 S Ferdon Blvd Ste A4 Crestview |
| State: | FL US |
| Postal Code: | 325365287 |
| Phone Number: | 8322025314 |
| Fax Number: | 2812208979 |
| NPI Enumeration Date: | 03/12/2012 |
| NPI Last Update Date: | 07/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ACN 375 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |