Coastal Village Primary Care | |
2 James Way Suite 209 Pismo Beach CA 93449-4976 | |
(805) 773-7440 | |
(805) 773-7448 |
Full Name | Coastal Village Primary Care |
---|---|
Speciality | Family Medicine |
Location | 2 James Way, Pismo Beach, California |
Authorized Official Name and Position | Joseph A. Cruz (GENERAL PARTNER) |
Authorized Official Contact | 8057737440 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Coastal Village Primary Care Po Box 428 Grover Beach CA 93483-0428 Ph: (805) 773-7440 | Coastal Village Primary Care 2 James Way Suite 209 Pismo Beach CA 93449-4976 Ph: (805) 773-7440 |
NPI Number | 1992738496 |
---|---|
Provider Enumeration Date | 07/08/2006 |
Last Update Date | 09/16/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992738496 | NPI | - | NPPES |
ZZZ06670Z | Other | CA | BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | A49080 (California) | Primary |
207R00000X | Internal Medicine | A70251 (California) | Secondary |
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› Verified 6 days ago
Coastal Village Primary Care, A Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 James Way, Ste 209, Pismo Beach, CA 93449 Phone: 805-773-7440 Fax: 805-773-7448 | |
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