Healthcare Provider Details

I. General information

NPI: 1508237629
Provider Name (Legal Business Name): PACIFIC CENTRAL COAST HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 11/16/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 W TEFFT ST
NIPOMO CA
93444-9190
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 805-929-2272
  • Fax: 805-929-6405
Mailing address:
  • Phone: 805-994-5485
  • Fax: 805-614-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

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