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General NPI Number Information
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NPI Number | 1891840088
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST URGENT CARE MEDICAL GROUP
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 340 EAST BETTERAVIA RD SUITE C
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City | SANTA MARIA
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State | CA
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Zip | 93454-7847
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Country | US
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Telephone | 805-922-0561
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Fax | 805-922-0083
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Provider Business Mailing Address
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Address Line | PO BOX 848722
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City | BOSTON
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State | MA
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Zip | 02284-8722
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Country | US
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Telephone | 805-922-0561
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Fax | 805-922-0083
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Authorized Official
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Title or Position | PHYSICIAN PARTNER
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Name | DR. THOMAS A CARUSO
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Credential | MD
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Telephone | 805-922-0561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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