NPIMap

Organization Active NPI

Coastal Cardiology a Medical Corp

  • Cardiovascular Disease Physician
  • San Luis Obispo, CA
National Provider Identifier
1720183569
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
COASTAL CARDIOLOGY A MEDICAL CORP
Practice address
1941 Johnson Ave Ste 101
San Luis Obispo, CA 93401-4154
Phone
(805) 782-8844
Fax
(813) 613-2634
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Authorized official

Name
Marissa Famularo
Title
Operations Manager
Phone
(805) 782-8844

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Interventional Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0011X A63687 CA
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X PA23186 CA

Addresses

Primary practice location

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

Mailing address

PO Box 12003
San Luis Obispo, CA 93406-2003
Phone (805) 782-8844

Other identifiers 3

IdentifierTypeStateIssuer
CP1074OtherMEDICARE RR
ZZZ24859ZOtherCABLUE SHIELD
GR0068680MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040830000921 CA Part B Supplier - Clinic/Group Practice 7416922760 Receives reassigned benefits from 11 practitioners
6 other NPIs on this enrollment
Practice locations: San Luis Obispo, CA; Templeton, CA; Arroyo Grande, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

310 S Halcyon Rd
Ste 105
Arroyo Grande, CA 93420
Phone (805) 481-8233

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757376000000",
    "number": "1720183569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12003",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934062003",
            "telephone_number": "805-782-8844",
            "fax_number": "805-540-5881"
        },
        {
            "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": "813-613-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARDIOLOGY A MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A",
        "authorized_official_last_name": "FAMULARO",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "805-782-8844"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "A63687",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA23186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CP1074",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ24859Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; 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.