Healthcare Provider Details

I. General information

NPI: 1891840088
Provider Name (Legal Business Name): CENTRAL COAST URGENT CARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EAST BETTERAVIA RD SUITE C
SANTA MARIA CA
93454-7847
US

IV. Provider business mailing address

PO BOX 848722
BOSTON MA
02284-8722
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-0561
  • Fax: 805-922-0083
Mailing address:
  • Phone: 805-922-0561
  • Fax: 805-922-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS A CARUSO
Title or Position: PHYSICIAN PARTNER
Credential: MD
Phone: 805-922-0561