Organization
CENTRAL COAST OTOLARYNGOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WIKHOLM M.D. (OWNER AND PHYSICIAN)
(805) 614-9250
Entity
Organization
Contact information
Practice address
116 S PALISADE DR STE 206, SANTA MARIA, CA 93454-8906
(805) 614-9250
Mailing address
116 S PALISADE DR STE 206, SANTA MARIA, CA 93454-8906
(805) 614-9250
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
PA13405
CA
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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