Provider Demographics
NPI:1730411828
Name:CENTRAL COAST MOBILITY
Entity type:Organization
Organization Name:CENTRAL COAST MOBILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TATREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-772-8210
Mailing Address - Street 1:358 QUINTANA RD
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2054
Mailing Address - Country:US
Mailing Address - Phone:805-772-8210
Mailing Address - Fax:
Practice Address - Street 1:358 QUINTANA RD
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2054
Practice Address - Country:US
Practice Address - Phone:805-772-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA097336332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03097FMedicaid
CA089322152OtherBLUE CROSS
CA089322152OtherBLUE CROSS