Organization
CENTRAL COAST PEDIATRICS INC
Active
Parent organization
CENTRAL COAST PEDIATRICS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRAL COAST PEDIATRICS INC
Authorized official
DR. RICHRD J MACIAS MD (PRES/CFO)
(805) 549-0888
Entity
Organization
Contact information
Practice address
1320 LAS TABLAS RD, SUITE D, TEMPLETON, CA 93465-9711
(805) 434-3796
Mailing address
1320 LAS TABLAS RD, SUITE D, TEMPLETON, CA 93465-9711
(805) 434-3796
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059300
—
CA
Enumeration date
11/20/2008
Last updated
05/05/2022
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