Organization
CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANNY LEROY LICKNESS M.D. (PRESIDENT)
(805) 544-8811
Entity
Organization
Contact information
Practice address
35 CASA STREET, SUITE 220, SAN LUIS OBISPO, CA 93405-1890
(805) 548-0775
(805) 548-0777
Mailing address
100 CASA STREET, SUITE B, SAN LUIS OBISPO, CA 93405-1893
(805) 548-0775
(805) 548-0777
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0092003
—
CA
Enumeration date
04/14/2008
Last updated
06/25/2010
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