Provider Demographics
NPI:1871743435
Name:CENTRAL COAST PATHOLOGY CONSULTANTS, INC.
Entity type:Organization
Organization Name:CENTRAL COAST PATHOLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-549-7461
Mailing Address - Street 1:3701 S HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7462
Mailing Address - Country:US
Mailing Address - Phone:805-549-7461
Mailing Address - Fax:805-549-7463
Practice Address - Street 1:3701 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7462
Practice Address - Country:US
Practice Address - Phone:805-549-7461
Practice Address - Fax:805-549-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0643503207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA82632AMedicare PIN
CAWA71757AMedicare PIN
CAWA72558BMedicare PIN
CAWA23785AMedicare PIN
CAWG76988AMedicare PIN
CAWA92649AMedicare PIN
CAHW13896Medicare PIN
CAWG86079AMedicare PIN
CAWG50091BMedicare PIN
CAWG34326BMedicare PIN
CAWG46098BMedicare PIN
CAWG81268AMedicare PIN
CACN6729Medicare PIN
CAWG37701AMedicare PIN