Organization
ASSOCIATED ANESTHESIOLOGISTS OF THE CENTRAL COAST
Active
Other names
COASTAL ANESTHESIOLOGY MEDICAL ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
BOB HETZEL (MANAGER)
(805) 550-1074
Entity
Organization
Contact information
Practice address
1010 MURRAY ST, SAN LUIS OBISPO, CA 93405
(805) 928-1731
(805) 349-8160
Mailing address
PO BOX 6406, SANTA MARIA, CA 93456-6406
(805) 928-1731
(805) 349-8160
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0084310
—
CA
01
—
ZZZ57363Z
BLUE SHIELD GROUP PROVIDE
CA
Enumeration date
09/26/2005
Last updated
05/17/2018
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