Healthcare Provider Details

I. General information

NPI: 1760423180
Provider Name (Legal Business Name): CENTRAL COAST ENDOSCOPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 GREEN VALLEY RD STE F
FREEDOM CA
95019-3133
US

IV. Provider business mailing address

1081 LOS PALOS DR
SALINAS CA
93901-3916
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-0407
  • Fax: 831-763-0101
Mailing address:
  • Phone: 831-763-0407
  • Fax: 831-763-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN G JOHNSON
Title or Position: DIRECTOR
Credential: MD
Phone: 831-800-7887