| Organization Name: | CENTRAL COAST KIDNEY DISEASE CENTER INC. |
| NPI Number: | 1033141254 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MUTHIYALIAH BABU (ADMINISTRATOR) |
| Mailing Address: | 2263 S. Depot Rd. Santa Maria |
| State: | CA US |
| Postal Code: | 93455 |
| Phone Number: | 8053498600 |
| Fax Number: | 8059285145 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 12/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |