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General NPI Number Information
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NPI Number | 1740267574
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST CHEST CONSULTANTS A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1428 PHILLIPS LN SUITE 203
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2537
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Country | US
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Telephone | 805-543-4407
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Fax | 805-543-4587
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Provider Business Mailing Address
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Address Line | PO BOX 12460
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406-2460
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Country | US
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Telephone | 805-548-1142
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Fax | 805-234-9985
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL J RYAN
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Credential | MD
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Telephone | 805-543-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A62340
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 2070377
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2070377
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License Number State | CA
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