# CENTRAL COAST OTOLARYNGOLOGY

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

## Provider details

- **NPI number:** 1043623960
- **Authorized official:** DR. RICHARD WIKHOLM M.D. (OWNER AND PHYSICIAN)
- **Authorized official phone:** (805) 614-9250

## Contact information

- **Practice address:** 116 S PALISADE DR STE 206, SANTA MARIA, CA 93454-8906
- **Practice address phone:** (805) 614-9250
- **Mailing address:** 116 S PALISADE DR STE 206, SANTA MARIA, CA 93454-8906
- **Mailing address phone:** (805) 614-9250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | PA13405 | CA | Yes |

## Other

- **Enumeration date:** 06/09/2014
- **Last updated:** 06/09/2014