Provider Demographics
NPI:1871687301
Name:COSTA CENTRAL MEDICAL GROUP
Entity Type:Organization
Organization Name:COSTA CENTRAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:PAUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:831-444-6200
Mailing Address - Street 1:323 N SANBORN RD STE E
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2243
Mailing Address - Country:US
Mailing Address - Phone:831-751-6200
Mailing Address - Fax:831-751-6220
Practice Address - Street 1:323 N SANBORN RD STE E
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2243
Practice Address - Country:US
Practice Address - Phone:831-751-6200
Practice Address - Fax:831-751-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75654173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty