Healthcare Provider Details

I. General information

NPI: 1942239157
Provider Name (Legal Business Name): DAVID E HARDESTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
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: 805-473-0700
  • Fax:
Mailing address:
  • Phone: 805-547-2224
  • Fax: 805-474-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number225148-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC55386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: