Healthcare Provider Details

I. General information

NPI: 1912352493
Provider Name (Legal Business Name): PACIFIC CENTRAL COAST HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 10/19/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 100
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

1414 E MAIN ST STE 201
SANTA MARIA CA
93454-4890
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-0700
  • Fax: 805-473-5931
Mailing address:
  • Phone: 805-994-5485
  • Fax: 805-680-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MERLO
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 805-739-3853