Healthcare Provider Details

I. General information

NPI: 1407855265
Provider Name (Legal Business Name): CENTRAL COAST CARDIOLOGY A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LOWER RAGSDALE DR #102
MONTEREY CA
93940-5817
US

IV. Provider business mailing address

230 SAN JOSE ST
SALINAS CA
93901-3901
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-3375
  • Fax: 831-233-5182
Mailing address:
  • Phone: 831-758-2100
  • Fax: 831-758-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY S. ALBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 831-758-2100