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General NPI Number Information
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NPI Number | 1326934332
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST GASTROENTEROLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 1663 DOMINICAN WAY STE 210
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1556
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Country | US
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Telephone | 831-260-3591
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Fax | 800-785-5318
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Provider Business Mailing Address
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Address Line | 416B MAIN ST
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City | SALINAS
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State | CA
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Zip | 93901-3306
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Country | US
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Telephone | 831-800-7887
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Fax | 831-998-7155
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | VIJAYA MUKTHINUTHALAPATI
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Credential | MD
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Telephone | 831-800-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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