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

Coastal Village Primary, Inc

Organization Family Medicine Physician · NPI 1396080511

Coastal Village Primary, Inc is a Family Medicine Physician in Pismo Beach, California. Licensed in California. Registered with an NPI since 2012.

Licensed in
CA
In the registry since
2012
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

2 James Way Ste 209
Pismo Beach, CA 93449-4973
Phone: (805) 773-7440
Fax: (805) 773-7448
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A49080 (CA)

Record details

NPI number1396080511
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joseph Cruz — President/Owner · (805) 773-7440
NPI enumeratedNovember 28, 2012
Last updated in NPPESNovember 28, 2012
Mailing address2 James Way, Suite 209, Pismo Beach, CA 93449-4973

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