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Organization
CENTRAL COAST RENAL CARE INC
Active
Organization
CENTRAL COAST RENAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SCOTT PENTON MD (PRESIDENT)
(805) 548-8585
Entity
Organization
Contact information
Practice address
1551 BISHOP ST BLDG A STE 110, SAN LUIS OBISPO, CA 93401-4692
(805) 548-8585
(805) 548-8589
Mailing address
1551 BISHOP ST BLDG A STE 110, SAN LUIS OBISPO, CA 93401-4692
(805) 548-8585
(805) 548-8589
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1221
SLO COUNTY MEDICAL SERVICES PROGRAM- GROUP PIN NUMBER
CA
01
—
C3163787
STATE CORPORATION NUMBER
CA
Enumeration date
10/31/2008
Last updated
07/21/2022
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