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
1941 JOHNSON AVE STE 101, SAN LUIS OBISPO, CA 93401-4154
(805) 782-8844
(813) 613-2634
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
—
—
207RI0011X
Interventional Cardiology Physician
A63687
CA
363AM0700X
Medical Physician Assistant
PA23186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP1074
MEDICARE RR
—
05
—
GR0068680
—
CA
01
—
ZZZ24859Z
BLUE SHIELD
CA
Enumeration date
09/14/2006
Last updated
09/09/2025
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