Healthcare Provider Details

I. General information

NPI: 1497857940
Provider Name (Legal Business Name): HINDS MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 PRINCESSA LN
PISMO BEACH CA
93449-3413
US

IV. Provider business mailing address

220 PRINCESSA LN
PISMO BEACH CA
93449-3413
US

V. Phone/Fax

Practice location:
  • Phone: 805-704-2835
  • Fax: 52-213-2998
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA75086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A6768
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT L HINDS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 805-704-2835