Provider Demographics
NPI:1598038242
Name:CENTRAL COAST OBSTETRICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:CENTRAL COAST OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:805-786-4111
Mailing Address - Street 1:100 CASA ST
Mailing Address - Street 2:STE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1883
Mailing Address - Country:US
Mailing Address - Phone:805-786-4111
Mailing Address - Fax:805-543-6357
Practice Address - Street 1:220 S PALISADE DR
Practice Address - Street 2:STE 204
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8902
Practice Address - Country:US
Practice Address - Phone:805-354-7101
Practice Address - Fax:805-354-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty