Provider Demographics
NPI:1033070370
Name:CENTRAL COAST NURSING HOME PHYSICIANS, INC.
Entity type:Organization
Organization Name:CENTRAL COAST NURSING HOME PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:OTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-800-7617
Mailing Address - Street 1:1375 E MAIN ST
Mailing Address - Street 2:SUITE 103, BOX 111
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-704-2108
Mailing Address - Fax:805-200-2335
Practice Address - Street 1:1405 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4801
Practice Address - Country:US
Practice Address - Phone:805-704-2108
Practice Address - Fax:805-200-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty