CENTRAL COAST PEDIATRICS INC NPI 1083869804

NPI Information

NPI: 1083869804
Provider Name: CENTRAL COAST PEDIATRICS INC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 05D0913049

Address:
1320 LAS TABLAS RD
SUITE D
TEMPLETON, CA
ZIP 93465
Phone: (805) 434-3796
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CENTRAL COAST PEDIATRICS INC is an adolescent medicine pediatrics in Templeton, CA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. CENTRAL COAST PEDIATRICS INC NPI is 1083869804. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1320 LAS TABLAS RD
SUITE D
TEMPLETON, CA
ZIP 93465-711
Phone: (805) 434-3796

The provider's authorized official is Richrd J Macias .
The authorized official title is Pres/cfo and has the following contact phone number (805) 549-0888.

The CLIA number assigned to this NPI record is 05D0913049 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/20/2008 and was last updated on 5/5/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0059300	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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