MEDICARE: PACIFIC CENTRAL COAST HEALTH CENTERS

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1538650825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC CENTRAL COAST HEALTH CENTERS

Provider Business Mailing Address
First Line	:	1414 E MAIN ST STE 201
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4890
Country	:	US
Telephone Number	:	805-994-5485
Fax Number	:	805-739-3982

Provider Business Practice Location Address
First Line	:	901 OAK PARK BLVD STE 101
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3409
Country	:	US
Telephone Number	:	805-481-2205
Fax Number	:	805-481-2206

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	BRANDON MERLO
Credential	:
Telephone Number	:	805-739-3853

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	11/16/2025

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