Organization
CARDIOVASCULAR CENTER OF LOMPOC A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY JOHN COUGHLIN M.D, F.A.C.C. (PRESIDENT)
(805) 735-7771
Entity
Organization
Contact information
Practice address
136 N 3RD ST STE 1, LOMPOC, CA 93436-7002
(805) 735-7771
(805) 735-9911
Mailing address
PO BOX 567, LOMPOC, CA 93438-0567
(805) 736-1875
(805) 735-9911
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
C31374
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C313740
—
CA
01
—
ZZZ38994Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/16/2006
Last updated
11/15/2010
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