Healthcare Provider Details

I. General information

NPI: 1285787556
Provider Name (Legal Business Name): CENTCO MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E OCEAN AVE
LOMPOC CA
93436-7020
US

IV. Provider business mailing address

1005 E OCEAN AVE
LOMPOC CA
93436-7020
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-7766
  • Fax: 805-735-6986
Mailing address:
  • Phone: 805-735-7766
  • Fax: 805-735-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MILTON W. LAIRD
Title or Position: OWNER
Credential:
Phone: 805-735-7766