Healthcare Provider Details

I. General information

NPI: 1083160808
Provider Name (Legal Business Name): CENTRAL COAST CRITICAL CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

5662 CALLE REAL #248
GOLETA CA
93117-2317
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-2775
  • Fax: 805-563-3680
Mailing address:
  • Phone: 805-682-2775
  • Fax: 805-563-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: NOAH STITES-HALLETT
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 805-682-2775