Healthcare Provider Details

I. General information

NPI: 1871687301
Provider Name (Legal Business Name): COSTA CENTRAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N SANBORN RD STE E
SALINAS CA
93905-2243
US

IV. Provider business mailing address

323 N SANBORN RD STE E
SALINAS CA
93905-2243
US

V. Phone/Fax

Practice location:
  • Phone: 831-751-6200
  • Fax: 831-751-6220
Mailing address:
  • Phone: 831-751-6200
  • Fax: 831-751-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA75654
License Number StateCA

VIII. Authorized Official

Name: JOSE MARIO PAUDA
Title or Position: OWNER
Credential: MEDICAL DOCTOR
Phone: 831-444-6200