Provider Demographics
NPI:1104025287
Name:CENTRAL COAST ALLERGY AND ASTHMA, A MEDICAL CORPORARTION
Entity Type:Organization
Organization Name:CENTRAL COAST ALLERGY AND ASTHMA, A MEDICAL CORPORARTION
Other - Org Name:MONTEREY ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:831-424-3300
Mailing Address - Street 1:45 E SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2903
Mailing Address - Country:US
Mailing Address - Phone:831-644-0900
Mailing Address - Fax:831-644-9221
Practice Address - Street 1:665 MUNRAS AVE STE 260
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3137
Practice Address - Country:US
Practice Address - Phone:831-644-0900
Practice Address - Fax:831-644-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071130Medicaid
CAZZZ19547ZMedicare Oscar/Certification