Healthcare Provider Details

I. General information

NPI: 1063884252
Provider Name (Legal Business Name): VILLAGE PEDIATRICS OF ARROYO GRANDE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATION WAY
ARROYO GRANDE CA
93420-3370
US

IV. Provider business mailing address

201 STATION WAY
ARROYO GRANDE CA
93420-3370
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-2828
  • Fax: 877-543-0162
Mailing address:
  • Phone: 805-473-2828
  • Fax: 877-543-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY S. THOMPSON
Title or Position: OWNER
Credential: M.D.
Phone: 805-473-2828