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General NPI Number Information
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NPI Number | 1144038282
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST RHEUMATOLOGY MEDICAL CORP
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 1655 DALIDIO DR UNIT 3151
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93403-7007
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Country | US
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Telephone | 805-316-0698
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Fax |
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Provider Business Mailing Address
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Address Line | 1655 DALIDIO DR UNIT 3151
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93403-7007
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Country | US
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Telephone | 805-316-0698
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIKITA PATEL
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Credential | M.D.
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Telephone | 805-316-0698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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