Healthcare Provider Details

I. General information

NPI: 1902317472
Provider Name (Legal Business Name): PACIFIC PSYCHIATRY INC., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 ELLA ST STE B
SAN LUIS OBISPO CA
93401-4166
US

IV. Provider business mailing address

1304 ELLA ST STE B
SAN LUIS OBISPO CA
93401-4166
US

V. Phone/Fax

Practice location:
  • Phone: 805-541-6000
  • Fax: 805-541-6001
Mailing address:
  • Phone: 805-541-6000
  • Fax: 805-541-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA065282
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA065282
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS MURPHY
Title or Position: OWNER
Credential: MD
Phone: 805-541-6000