Central Coast Obstetrics & Gynecology, Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.

Practice address

35 Casa Street
Suite 220
San Luis Obispo, CA 93405-1890

Phone

(805) 548-0775

Fax

(805) 548-0777

NPI assigned

Apr 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Danny Leroy Lickness, MD

Title

President

Phone

(805) 544-8811

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1013181817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CASA STREET",
            "address_2": "SUITE B",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051893",
            "telephone_number": "805-548-0775",
            "fax_number": "805-548-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 CASA STREET",
            "address_2": "SUITE 220",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051890",
            "telephone_number": "805-548-0775",
            "fax_number": "805-548-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COAST OBSTETRICS & GYNECOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "LICKNESS",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-544-8811",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0092200",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Central Coast Lymphedema Therapy
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• Central Coast Neurological Surgery PC
• Central Coast Neurology Medical Group, Inc
• Central Coast Nursing Home Physicians, Inc.
• Central Coast Obstetrics & Gynecology, Inc.
• Central Coast Obstetrics and Gynecology, Inc., a Medical Group
• Central Coast Orthopedic Medical Group
• Central Coast Outpatient Program
• Central Coast Pain Management Specialists, Inc.

• Obstetrics & Gynecology Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.