Provider Demographics
NPI:1144781519
Name:CENTRAL COAST FUNCTIONAL RESTORATION PROGRAM INC
Entity Type:Organization
Organization Name:CENTRAL COAST FUNCTIONAL RESTORATION PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-464-7246
Mailing Address - Street 1:1260 41ST AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3929
Mailing Address - Country:US
Mailing Address - Phone:831-464-7246
Mailing Address - Fax:831-464-7744
Practice Address - Street 1:1260 41ST AVE STE D
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3929
Practice Address - Country:US
Practice Address - Phone:831-464-7246
Practice Address - Fax:831-464-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty