Healthcare Provider Details

I. General information

NPI: 1093140972
Provider Name (Legal Business Name): AMBER ROSE HULLIBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4535
US

IV. Provider business mailing address

437 KENTUCKY ST #F
SAN LUIS OBISPO CA
93405-1970
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4700
  • Fax:
Mailing address:
  • Phone: 310-529-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: