Healthcare Provider Details

I. General information

NPI: 1356150742
Provider Name (Legal Business Name): NEUROWELL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 E GRAND AVE STE C2
ARROYO GRANDE CA
93420-2565
US

IV. Provider business mailing address

882 AUKLET CT
ARROYO GRANDE CA
93420-5539
US

V. Phone/Fax

Practice location:
  • Phone: 805-900-7672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRADLEY K GUION
Title or Position: VP
Credential:
Phone: 602-503-9869