Healthcare Provider Details

I. General information

NPI: 1609466838
Provider Name (Legal Business Name): JOSEPH HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 JOHNSON AVE
SAN LUIS OBISPO CA
93401-4535
US

IV. Provider business mailing address

1797 MANHATTAN AVE
GROVER BEACH CA
93433-2585
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4723
  • Fax: 805-781-4145
Mailing address:
  • Phone: 805-722-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: