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General NPI Number Information
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NPI Number | 1326825308
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST MD MEDICAL SUPPLIES AND UNIFORMS
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 901 SUNSET DR STE 4
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City | HOLLISTER
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State | CA
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Zip | 95023-5613
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Country | US
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Telephone | 831-588-7767
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 41ST AVE STE 102-259
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City | CAPITOLA
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State | CA
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Zip | 95010-2513
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Country | US
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Telephone | 831-588-7767
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION MANAGER
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Name | CHRISTINE CUMMING
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Credential |
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Telephone | 831-588-7767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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