Healthcare Provider Details

I. General information

NPI: 1699664235
Provider Name (Legal Business Name): CENTRAL COAST ENDOSCOPY CENTER OF WATSONVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WESTGATE DR STE 201
WATSONVILLE CA
95076-2453
US

IV. Provider business mailing address

416B MAIN ST
SALINAS CA
93901-3306
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-7887
  • Fax:
Mailing address:
  • Phone: 831-800-7887
  • Fax: 831-998-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN G JOHNSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 831-800-7887