Organization
CENTRAL COAST KIDNEY DISEASE CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUTHIYALIAH BABU M.D. (ADMINISTRATOR)
(805) 349-0198
Entity
Organization
Contact information
Practice address
2263 S. DEPOT RD., SANTA MARIA, CA 93455
(805) 349-8600
(805) 928-5145
Mailing address
116 S PALISADE DR, 100, SANTA MARIA, CA 93454-8904
(805) 614-0694
(805) 349-9004
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02871F
—
CA
Enumeration date
07/07/2006
Last updated
12/07/2011
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