Healthcare Provider Details

I. General information

NPI: 1235262734
Provider Name (Legal Business Name): FAMILY & INDUSTRIAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SANTA ROSA ST
SAN LUIS OBISPO CA
93405-5816
US

IV. Provider business mailing address

47 SANTA ROSA ST
SAN LUIS OBISPO CA
93405-5816
US

V. Phone/Fax

Practice location:
  • Phone: 805-542-9596
  • Fax: 805-542-0845
Mailing address:
  • Phone: 805-542-9596
  • Fax: 805-542-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA M LANDIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-547-1255