Healthcare Provider Details

I. General information

NPI: 1558858035
Provider Name (Legal Business Name): HULLANDER AND MOZINGO LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BISHOP ST STE 220
SAN LUIS OBISPO CA
93401-4661
US

IV. Provider business mailing address

222 W PUEBLO ST
SANTA BARBARA CA
93105-3805
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-0363
  • Fax: 805-563-0364
Mailing address:
  • Phone: 805-563-0363
  • Fax: 805-563-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberG68228
License Number StateCA

VIII. Authorized Official

Name: JUSTINE HOLMLUND
Title or Position: MANAGER
Credential:
Phone: 805-563-0363