Organization
CENTRAL COAST REGENERATIVE MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEXIS E KHAN (OWNER, AUTHORIZED OFFICIAL)
(530) 415-6549
Entity
Organization
Contact information
Practice address
628 CALIFORNIA BLVD STE E, SAN LUIS OBISPO, CA 93401-2548
(805) 540-2010
Mailing address
628 CALIFORNIA BLVD STE E, SAN LUIS OBISPO, CA 93401-2548
(805) 540-2010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/20/2019
Last updated
04/23/2021
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