Organization
PACIFIC CENTRAL COAST HEALTH CENTERS
Active
Parent organization
PACIFIC CENTRAL COAST HEALTH CENTERS
Other names
Marian Community Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PACIFIC CENTRAL COAST HEALTH CENTERS
Authorized official
MATTHEW RICHARDSON (CHIEF FINANCIAL OFFICER)
(805) 739-3108
Entity
Organization
Contact information
Practice address
1745 N BROADWAY STE 101, SANTA MARIA, CA 93454-1940
(805) 739-3890
(805) 347-7697
Mailing address
1414 E MAIN ST STE 201, SANTA MARIA, CA 93454-4890
(805) 994-5485
(805) 614-5871
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70597G
—
CA
05
—
CMM70597O
—
CA
05
—
EAP03882G
—
CA
01
—
ZZZ06481Z
BLUE SHIELD OF CA
—
Enumeration date
12/06/2005
Last updated
04/03/2023
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