Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Coastal Community Center Inc

Organization Internal Medicine Physician · NPI 1295690527

Coastal Community Center Inc is an Internal Medicine Physician in Provo, Utah. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3650 N University Ave Ste 150
Provo, UT 84604-6636
Phone: (702) 809-2505
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X
Internal Medicine Physician Taxonomy 207R00000X

Record details

NPI number1295690527
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ayushmaan Srinivasa — Board Member · (702) 809-2505
NPI enumeratedDecember 18, 2025
Last updated in NPPESDecember 18, 2025
Certification dateDecember 18, 2025
Mailing address3650 N University Ave Ste 150, Provo, UT 84604-6636

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