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General NPI Number Information
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NPI Number | 1073739025
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST HEALTHCARE, A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 09/17/2012
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Provider Practice Location Address
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Address Line | 9700 EL CAMINO REAL STE 100
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City | ATASCADERO
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State | CA
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Zip | 93422-5571
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Country | US
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Telephone | 805-461-9000
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Fax | 805-461-9001
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Provider Business Mailing Address
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Address Line | 9700 EL CAMINO REAL STE 100
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City | ATASCADERO
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State | CA
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Zip | 93422-5571
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Country | US
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Telephone | 805-461-9000
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Fax | 805-461-9001
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM SUTTON
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Credential |
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Telephone | 805-461-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | CA
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