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General NPI Number Information
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NPI Number | 1619037975
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST ALLERGY AND ASTHMA
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 45 E SAN JOAQUIN ST
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City | SALINAS
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State | CA
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Zip | 93901-2903
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Country | US
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Telephone | 831-424-3300
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Fax | 831-758-4094
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Provider Business Mailing Address
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Address Line | 45 E SAN JOAQUIN ST
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City | SALINAS
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State | CA
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Zip | 93901-2903
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Country | US
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Telephone | 831-424-3300
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Fax | 831-758-4094
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Authorized Official
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Title or Position | CREDENTIALING LIAISON
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Name | MICHAEL ELISSA SMOTHERMAN
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Credential |
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Telephone | 775-674-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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