Provider Demographics
NPI:1558320143
Name:CENTRAL COAST PATHOLOGY CONSULTANTS, INC
Entity Type:Organization
Organization Name:CENTRAL COAST PATHOLOGY CONSULTANTS, INC
Other - Org Name:CCPC CLINICAL LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-541-6033
Mailing Address - Street 1:PO BOX 8139
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-8139
Mailing Address - Country:US
Mailing Address - Phone:805-549-7461
Mailing Address - Fax:805-549-7463
Practice Address - Street 1:3701 S HIGUERA ST
Practice Address - Street 2:STE. 200
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7462
Practice Address - Country:US
Practice Address - Phone:805-541-6033
Practice Address - Fax:805-541-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058760Medicaid
CALAB43503FMedicaid
CAX058954Medicare PIN
CACN6729Medicare PIN
CAH83641Medicare UPIN
CAA92951Medicare UPIN
CAH60009Medicare UPIN
CAF05903Medicare UPIN
CALAB43503FMedicaid
CAA47199Medicare UPIN
CAF24847Medicare UPIN
CAH06171Medicare UPIN
CAGR0058760Medicaid
CAF05904Medicare UPIN
CAF05905Medicare UPIN
CAG36485Medicare UPIN