Provider Demographics
NPI:1083160808
Name:CENTRAL COAST CRITICAL CARE ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL COAST CRITICAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STITES-HALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-2775
Mailing Address - Street 1:5662 CALLE REAL
Mailing Address - Street 2:#248
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2317
Mailing Address - Country:US
Mailing Address - Phone:805-682-2775
Mailing Address - Fax:805-563-3680
Practice Address - Street 1:400 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4353
Practice Address - Country:US
Practice Address - Phone:805-682-2775
Practice Address - Fax:805-563-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty