Healthcare Provider Details

I. General information

NPI: 1093622920
Provider Name (Legal Business Name): RAMON HERNANDEZ MONREAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 SAN LUIS DR
SAN LUIS OBISPO CA
93401-3060
US

IV. Provider business mailing address

1499 SAN LUIS DR
SAN LUIS OBISPO CA
93401-3060
US

V. Phone/Fax

Practice location:
  • Phone: 805-596-4040
  • Fax:
Mailing address:
  • Phone: 800-549-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number260128055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: