Pacific Central Coast Health Centers

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

PACIFIC CENTRAL COAST HEALTH CENTERS

Practice address

1941 Johnson Ave Ste 101
San Luis Obispo, CA 93401-4154

Phone

(805) 782-8844

Fax

(833) 613-2634

NPI assigned

Jul 9, 2024

Organization subpart

Yes

Parent organization

PACIFIC CENTRAL COAST HEALTH CENTERSAs reported in NPPES

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

Authorized official

Name

Matthew Richardson

Title

Chief Financial Officer

Phone

(805) 739-3108

Specialties & licenses 1

Addresses

Other names 1

• Coastal Cardiology - San Luis Obispo Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Pacific Central Coast Health Centers

Locations

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1467299388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 E MAIN ST STE 201",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544890",
            "telephone_number": "805-994-5485",
            "fax_number": "805-614-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE STE 101",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014154",
            "telephone_number": "805-782-8844",
            "fax_number": "833-613-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CENTRAL COAST HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC CENTRAL COAST HEALTH CENTERS",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-739-3108"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Cardiology - San Luis Obispo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Lee Pacaoan
• Thomas Pacheco, D.D.S
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers
• Pacific Central Coast Health Centers

• All providers in San Luis Obispo, CA
• Community Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.