Healthcare Provider Details

I. General information

NPI: 1366904963
Provider Name (Legal Business Name): NATHANIEL PARKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TEJAS PL
NIPOMO CA
93444-9123
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-3211
  • Fax: 805-929-6359
Mailing address:
  • Phone: 805-361-8030
  • Fax: 805-361-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: