Healthcare Provider Details

I. General information

NPI: 1144376740
Provider Name (Legal Business Name): PETER SEBASTIAN MASNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 100
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

850 FAIR OAKS AVE STE 220
ARROYO GRANDE CA
93420-3929
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-2224
  • Fax: 805-547-2228
Mailing address:
  • Phone: 805-547-2224
  • Fax: 805-474-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA113136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: