Organization
COASTAL CARDIOLOGY A MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA FAMULARO (OPERATIONS MANAGER)
(805) 782-8844
Entity
Organization
Contact information
Practice address
310 SOUTH HALCYON ROAD STE 105, ARROYO GRANDE, CA 93420-3872
(805) 782-8844
(813) 613-2632
Mailing address
PO BOX 12003, SAN LUIS OBISPO, CA 93406-2003
(805) 782-8844
(805) 540-5881
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
CA
207RI0011X
Interventional Cardiology Physician
A114658
CA
363AM0700X
Medical Physician Assistant
PA23186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0068680
—
CA
01
—
ZZZ24859Z
BLUE SHIELD
CA
Enumeration date
07/01/2008
Last updated
09/09/2025
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