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General NPI Number Information
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NPI Number | 1265806020
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Entity Type | Organization
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Legal Business Name | PACIFIC CENTRAL COAST HEALTH CENTERS
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 206 S STRATFORD AVE SUITE B
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City | SANTA MARIA
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State | CA
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Zip | 93454-5901
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Country | US
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Telephone | 805-474-5807
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Fax | 805-474-5808
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Provider Business Mailing Address
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Address Line | 117 W BUNNY AVE
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City | SANTA MARIA
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State | CA
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Zip | 93458-2805
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Country | US
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Telephone | 805-739-3474
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Fax | 805-614-5956
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MATTHEW RICHARDSON
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Credential |
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Telephone | 805-739-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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