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NPI Code Detail

MEDICARE: BRIAN TWADDELL

MEDICARE: BRIAN TWADDELL
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
1167G00000XLicensed Psychiatric Technician34029CA

General Provider Information

NPI Number : 1891230694
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN TWADDELL
Provider Business Mailing Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-461-6060
Fax Number :
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 : 805-461-6060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2017
Last Update Date : 05/07/2026

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