Provider Demographics
NPI:1619037975
Name:CENTRAL COAST ALLERGY AND ASTHMA
Entity Type:Organization
Organization Name:CENTRAL COAST ALLERGY AND ASTHMA
Other - Org Name:SALINAS ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ELISSA
Authorized Official - Last Name:SMOTHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-674-5668
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:831-424-3300
Mailing Address - Fax:831-758-4094
Practice Address - Street 1:45 E SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2903
Practice Address - Country:US
Practice Address - Phone:831-424-3300
Practice Address - Fax:831-758-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071130Medicaid
CAGR0071130Medicaid