Provider Demographics
NPI:1588668271
Name:CENTRAL COAST MEDICAL ONCOLOGY CORP
Entity Type:Organization
Organization Name:CENTRAL COAST MEDICAL ONCOLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLOTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-349-9393
Mailing Address - Street 1:1325 E CHURCH ST
Mailing Address - Street 2:STE. 301
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-349-9393
Mailing Address - Fax:805-349-1155
Practice Address - Street 1:1325 E CHURCH ST
Practice Address - Street 2:STE. 301
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-349-9393
Practice Address - Fax:805-349-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RH0003X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18159Medicare PIN