Healthcare Provider Details

I. General information

NPI: 1588668271
Provider Name (Legal Business Name): CENTRAL COAST MEDICAL ONCOLOGY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E CHURCH ST STE. 301
SANTA MARIA CA
93454
US

IV. Provider business mailing address

1325 E CHURCH ST STE. 301
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-349-9393
  • Fax: 805-349-1155
Mailing address:
  • Phone: 805-349-9393
  • Fax: 805-349-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. MELODY A PLOTNER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 805-349-9393