1285808733 NPI number — CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.

Table of content: (NPI 1285808733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285808733 NPI number — CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.
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:
1285808733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CASA STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93465-4060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-548-0775
Provider Business Mailing Address Fax Number:
805-548-0777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 POSADA LANE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TEMPLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93405-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-434-5497
Provider Business Practice Location Address Fax Number:
805-434-0917
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LICKNESS
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
LEROY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-544-8811

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0092204 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com