Provider Demographics
NPI:1659159705
Name:COASTAL PACIFIC ANESTHESIA
Entity Type:Organization
Organization Name:COASTAL PACIFIC ANESTHESIA
Other - Org Name:CALIFORNIA COAST CHILDREN'S DENTAL SURGERY CENTER INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP, CRNA
Authorized Official - Phone:775-747-5050
Mailing Address - Street 1:2950 BROAD ST UNIT 1121
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6702
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:
Practice Address - Street 1:816 E ENOS DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8205
Practice Address - Country:US
Practice Address - Phone:775-747-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty