{"npi":"1720183569","type":"NPI-2","status":"active","name":{"display":"Coastal Cardiology A Medical Corp","other":[],"organization_name":"COASTAL CARDIOLOGY A MEDICAL CORP","authorised_official":"Marissa Famularo"},"specialty":{"primary_taxonomy":"207RC0000X","primary_taxonomy_description":"Cardiovascular Disease","slug":"cardiology","schema_org_specialty":"Cardiovascular","all":[{"code":"363AM0700X","description":"Medical Physician Assistant","primary":false,"state":"CA","license":"PA23186"},{"code":"207RI0011X","description":"Interventional Cardiology","primary":false,"state":"CA","license":"A63687"},{"code":"207RC0000X","description":"Cardiovascular Disease","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"1941 JOHNSON AVE STE 101","city":"SAN LUIS OBISPO","state":"CA","postal_code":"934014154","country_code":"US","phone":"8057828844","fax":"8136132634"},{"purpose":"MAILING","street_1":"PO BOX 12003","city":"SAN LUIS OBISPO","state":"CA","postal_code":"934062003","country_code":"US","phone":"8057828844","fax":"8055405881"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"CP1074","state":null,"issuer":"MEDICARE RR"},{"type_code":"01","label":"Other","value":"ZZZ24859Z","state":"CA","issuer":"BLUE SHIELD"},{"type_code":"05","label":"Medicaid","value":"GR0068680","state":"CA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20040830000921","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"CA","pac_id":"7416922760"}]},"enumeration_date":"2006-09-14","last_updated":"2025-09-09","_meta":{"source":"NPPES","snapshot_date":"2025-09-09","doc_url":"https://findmynpi.com/api"}}