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
295 POSADA LANE SUITE A, TEMPLETON, CA 93465-4055
(805) 782-8844
(813) 613-2635
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
G44009
CA
207RI0011X
Interventional Cardiology Physician
G69997
CA
363AM0700X
Medical Physician Assistant
PA23186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP1074
RR MEDICARE
CA
05
—
GR0068680
—
CA
01
—
ZZZ40450Z
BLUE SHIELD
CA
Enumeration date
07/01/2008
Last updated
09/09/2025
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