1891589438 NPI number — CENTRAL COAST OVERDOSE PREVENTION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891589438 NPI number — CENTRAL COAST OVERDOSE PREVENTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL COAST OVERDOSE PREVENTION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891589438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93942-2101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-682-5008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 DEER STALKER PATH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-226-3717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2025

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN WHITED
Authorized Official First Name:
KHANH
Authorized Official Middle Name:
ALEXANDER NGOC
Authorized Official Title or Position:
SYSTEM ADMINISTRATOR
Authorized Official Telephone Number:
650-469-2218

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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