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General NPI Number Information
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NPI Number | 1104092188
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 920 W HOLLOW DR
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City | PASO ROBLES
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State | CA
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Zip | 93446
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Country | US
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Telephone | 805-703-0024
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Fax | 888-275-1229
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Provider Business Mailing Address
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Address Line | 13668 LAKESHORE DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-9443
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Country | US
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Telephone | 805-703-0024
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Fax | 888-275-1229
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. JOSEPH DANIEL ORTIZ
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Credential | MD
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Telephone | 805-703-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A87187
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License Number State | CA
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