Basic Information
| Provider Information | |||||||||
| NPI: | 1598038242 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL COAST OBSTETRICS AND GYNECOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CASA ST | ||||||||
| Address2: | STE B | ||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934051883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057864111 | ||||||||
| FaxNumber: | 8055436357 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 S PALISADE DR | ||||||||
| Address2: | STE 204 | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934548902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053547101 | ||||||||
| FaxNumber: | 8053547102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2012 | ||||||||
| LastUpdateDate: | 02/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | THIELSCHER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8057864111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.