Healthcare Provider Details

I. General information

NPI: 1689549461
Provider Name (Legal Business Name): CENTRAL COAST MEDICAL AESTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E CALDWELL AVE UNIT A
VISALIA CA
93277-7605
US

IV. Provider business mailing address

215 E CALDWELL AVE UNIT A
VISALIA CA
93277-7605
US

V. Phone/Fax

Practice location:
  • Phone: 559-409-2048
  • Fax:
Mailing address:
  • Phone: 559-409-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIANNE SIMOES
Title or Position: OWNER
Credential: NP
Phone: 559-409-2048