Organization
CENTRAL COAST PEDIATRICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD J MACIAS M.D. (PRESIDENT/CFO)
(805) 549-0888
Entity
Organization
Contact information
Practice address
1235 OSOS ST, SUITE 100, SAN LUIS OBISPO, CA 93401-3600
(805) 549-0888
(805) 549-8463
Mailing address
1235 OSOS ST, SUITE 100, SAN LUIS OBISPO, CA 93401-3600
(805) 549-0888
(805) 549-8463
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059300
—
CA
Enumeration date
07/10/2006
Last updated
05/05/2022
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