Healthcare Provider Details

I. General information

NPI: 1306871082
Provider Name (Legal Business Name): DAVID LEROY MCBRIDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MAIN ST STE. B & C
CAMBRIA CA
93428-3407
US

IV. Provider business mailing address

150 TEJAS PL PO BOX 430
NIPOMO CA
93444-9123
US

V. Phone/Fax

Practice location:
  • Phone: 805-927-5292
  • Fax: 805-927-0354
Mailing address:
  • Phone: 805-929-3211
  • Fax: 805-929-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG55266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: