# CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013181817
- **Authorized official:** MR. DANNY LEROY LICKNESS MD (PRESIDENT)
- **Authorized official phone:** (805) 544-8811

## Contact information

- **Practice address:** 35 CASA STREET, SUITE 220, SAN LUIS OBISPO, CA 93405-1890
- **Practice address phone:** (805) 548-0775
- **Practice address fax:** (805) 548-0777
- **Mailing address:** 100 CASA STREET, SUITE B, SAN LUIS OBISPO, CA 93405-1893
- **Mailing address phone:** (805) 548-0775
- **Mailing address fax:** (805) 548-0777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/14/2008
- **Last updated:** 06/24/2010