MEDICARE: CENTRAL COAST MOVEMENT DISORDERS SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	20A12263	CA

General Provider Information

NPI Number	:	1215398953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL COAST MOVEMENT DISORDERS SPECIALISTS

Provider Business Mailing Address
First Line	:	515 E MICHELTORENA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-2257
Country	:	US
Telephone Number	:	805-563-3234
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 E MICHELTORENA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-2257
Country	:	US
Telephone Number	:	805-563-3234
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARAH KEMPLE-MEHL
Credential	:	MD
Telephone Number	:	805-563-3234

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/08/2016

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