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General NPI Number Information
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NPI Number | 1427382811
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST OTOLARYNGOLOGY
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 116 S PALISADE DR SUITE 206
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City | SANTA MARIA
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State | CA
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Zip | 93454-8904
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Country | US
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Telephone | 805-614-9250
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Fax |
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Provider Business Mailing Address
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Address Line | 116 S PALISADE DR STE 206
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City | SANTA MARIA
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State | CA
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Zip | 93454-8904
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Country | US
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Telephone | 805-614-9250
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Fax | 805-614-9260
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELIZABETH WIKHOLM
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Credential |
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Telephone | 805-614-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) 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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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