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General NPI Number Information
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NPI Number | 1255768057
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST MEDICAL GROUP
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 119 S B ST
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City | LOMPOC
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State | CA
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Zip | 93436-6903
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Country | US
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Telephone | 805-740-9400
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Fax | 805-741-2640
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Provider Business Mailing Address
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Address Line | 119 S B ST
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City | LOMPOC
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State | CA
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Zip | 93436-6903
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Country | US
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Telephone | 805-740-9400
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Fax | 805-741-2640
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN MICHAEL SAWYER
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Credential | M.D.
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Telephone | 805-740-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G71040
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License Number State | CA
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