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General NPI Number Information
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NPI Number | 1083863468
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST DERMATOLOGY, INC.
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 977 PACIFIC ST SUITE B
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City | MONTEREY
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State | CA
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Zip | 93940-4400
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Country | US
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Telephone | 831-648-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 977 PACIFIC ST SUITE B
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City | MONTEREY
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State | CA
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Zip | 93940-4400
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Country | US
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Telephone | 831-648-8000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD M HAMBLEY
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Credential | MD
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Telephone | 831-648-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | FNP37805
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License Number State | CA
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