Affiliated Pathologists of the Central Coast
Organization Active NPI Anatomic Pathology & Clinical Pathology Physician · San Luis Obispo, CA
NPI 1568702017 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1568702017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 05D0921025 (CA)
- Legal business name
- AFFILIATED PATHOLOGISTS OF THE CENTRAL COAST
- Practice address
- 1010 Murray Ave
San Luis Obispo, CA 93405-1806 - Phone
- (805) 546-7600
- NPI assigned
- Feb 20, 2013
- Organization subpart
- No
Authorized official
- Name
- Wendy Antonio
- Title
- Bookkeeper
- Phone
- (805) 710-7308
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 4
Practitioners 3
-
Ronald E Rocha, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130423000104 | CA | Part B Supplier - Clinic/Group Practice | 9436395266 |
Receives reassigned benefits from 3 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: San Luis Obispo, CA; Templeton, CA |
National Provider Directory
- Tax ID family
- Affiliated Pathologists of the Central Coast
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician |
207ZC0500X | |||
| Anatomic Pathology & Clinical Pathology Physician |
207ZP0102X | 05D0921025 | CA | Yes |
Addresses
Primary practice location
1010 Murray Ave
San Luis Obispo, CA 93405-1806
Mailing address
PO Box 5007
San Luis Obispo, CA 93403-5007
Phone (805) 710-7308
Other providers in San Luis Obispo, CA
- Aesthetic Eye Care
- Aevum Home Health Inc.
- Aevum Hospice Inc.
- Aevum Hospice LLC
- Affiliated Pathologists of the Central Coast
- Affiliated Pathologists of the Central Coast
- Affinity Chiropractic Center
- Peter F. Afsari
- Daniel Rahul Agarwal
- Adrianna Y Aguilar
All providers in San Luis Obispo, CA · Anatomic Pathology & Clinical Pathology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.