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NPI Code Detail

MEDICARE: CENTRAL COAST PATHOLOGY CONSULTANTS, INC

MEDICARE: CENTRAL COAST PATHOLOGY CONSULTANTS, INC
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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558320143
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL COAST PATHOLOGY CONSULTANTS, INC
Provider Business Mailing Address
First Line : PO BOX 8139
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93403-8139
Country : US
Telephone Number : 805-549-7461
Fax Number : 805-549-7463
Provider Business Practice Location Address
First Line : 3701 S HIGUERA ST
Second Line : STE. 200
City : SAN LUIS OBISPO
State : CA
Zip : 93401-7462
Country : US
Telephone Number : 805-541-6033
Fax Number : 805-541-6116
Authorized Official
Title or Position : PRESIDENT/PATHOLOGIST
Name : MR. RONALD E ROCHA
Credential : M.D.
Telephone Number : 805-541-6033
Provider Enumeration Date : 03/21/2006
Last Update Date : 12/09/2010

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