Organization
CENTRAL COAST HEADWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. E. MOORE (DIRECTOR)
(805) 922-2106
Entity
Organization
Contact information
Practice address
318 WEST CARMEN AVE, SANTA MARIA, CA 93458-7754
(805) 922-2106
Mailing address
318 CARMEN LN, SANTA MARIA, CA 93458-7754
(805) 922-2106
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25
AGENCY
CA
Enumeration date
04/26/2007
Last updated
08/22/2020
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