Provider Demographics
NPI:1891855193
Name:CENTRAL COAST VASCULAR, INC.
Entity Type:Organization
Organization Name:CENTRAL COAST VASCULAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:SKILLERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-643-3330
Mailing Address - Street 1:100 N BRENT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2822
Mailing Address - Country:US
Mailing Address - Phone:805-643-3300
Mailing Address - Fax:805-643-3331
Practice Address - Street 1:100 N BRENT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2822
Practice Address - Country:US
Practice Address - Phone:805-643-3300
Practice Address - Fax:805-643-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty