COASTAL DETOX OF SOUTHERN CALIFORNIA LLC
NPI 1003536830
Substance Abuse Rehabilitation Facility in San Diego, CA
About Coastal Detox Of Southern California Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COASTAL DETOX OF SOUTHERN CALIFORNIA LLC (NPI 1003536830) is a healthcare organization registered as a substance abuse rehabilitation facility in San Diego, California and active in the NPI registry since August 2022. The organization holds a CLIA Waiver certificate valid through July 16, 2028 and lists Mercedes Cornejo, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2307901
Coastal Detox Of Southern California LLC · San Diego, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Coastal Detox Of Southern California LLC's NPI number?
The NPI number for Coastal Detox Of Southern California LLC is 1003536830. It was assigned to this organization in the NPPES registry on August 31, 2022.
Where is Coastal Detox Of Southern California LLC located?
Coastal Detox Of Southern California LLC is located at 2574 Pico Way, San Diego, CA 92109. The listed phone number is (619) 386-7740.
What is Coastal Detox Of Southern California LLC's specialty?
The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.
Does Coastal Detox Of Southern California LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2307901) is associated with this NPI, valid through July 16, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Coastal Detox Of Southern California LLC was last updated on July 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Coastal Detox Of Southern California Llc · NPI 1003536830
Substance Abuse Rehabilitation Facility organization in San Diego, California. Organization record, active in the CMS NPPES registry since August 31, 2022.
## Identity
- **NPI:** 1003536830 (Entity type: Organization)
- **Enumerated:** August 31, 2022
- **Primary specialty:** Substance Abuse Rehabilitation Facility · taxonomy 324500000X
- **Organization subpart:** No
- **Authorized official:** Mercedes Cornejo, CEO
## Practice location
- **Address:** 2574 PICO WAY, San Diego, CA 92109-3811
- **Phone:** (619) 386-7740
## Record status
- **NPPES last updated:** July 23, 2026
- **Other identifiers:** Other 370207AP (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1003536830) · Data from the CMS NPPES public registry.