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NPI Code Detail

MEDICARE: COUNTY OF SAN LUIS OBISPO

MEDICARE: COUNTY OF SAN LUIS OBISPO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073501870
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF SAN LUIS OBISPO
Provider Business Mailing Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4700
Fax Number : 805-781-1273
Provider Business Practice Location Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4700
Fax Number : 805-781-1273
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : M. DAISY ILANO
Credential : M.D.
Telephone Number : 805-781-4700
Provider Enumeration Date : 10/06/2005
Last Update Date : 08/22/2013

Similar Medicare Providers

1306357603 — SAVANNAH MICHELE DONOVAN
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-781-4712
Practice Fax:
1780858068 — CHRISTOPHER M LEE ACSW
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-781-4700
Practice Fax:
1649475104 — MS. NANCI JANE RUIZ LPT
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-781-4700
Practice Fax: 805-781-1232
1114919263 — DR. JEFFREY BRUCE ELLIOTT PSYD
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-781-5525
Practice Fax: 805-781-1232
1861426652 — RONALD G MORGAN M.D.
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-473-7060
Practice Fax: 805-473-7124
1336165125 — STEPHEN T. PENEPACKER MD
Practice Location Address:
2178 JOHNSON AVE
SAN LUIS OBISPO, CA
93401-4535
Practice Phone: 805-781-4700
Practice Fax: 805-781-1232

Directions to “COUNTY OF SAN LUIS OBISPO ” Practice Location

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