Healthcare Provider Details

I. General information

NPI: 1568027043
Provider Name (Legal Business Name): CENTRAL COAST CARDIOVASCULAR GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S PATTERSON AVE STE 208
SANTA BARBARA CA
93111-2400
US

IV. Provider business mailing address

2937 LOMA VISTA RD
VENTURA CA
93003-2915
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-0497
  • Fax: 805-638-0322
Mailing address:
  • Phone: 805-648-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AUBREY TRAUB
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-967-0497