Healthcare Provider Details

I. General information

NPI: 1215279781
Provider Name (Legal Business Name): COUNTY OF SAN LUIS OBISPO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 NIBLICK RD
PASO ROBLES CA
93446-4858
US

IV. Provider business mailing address

2180 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4513
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4753
  • Fax: 805-781-1227
Mailing address:
  • Phone: 805-781-4753
  • Fax: 805-781-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STARLENE M GRABER
Title or Position: DIVISION MANAGER
Credential: PHD, LMFT
Phone: 805-781-4753