Healthcare Provider Details

I. General information

NPI: 1225188105
Provider Name (Legal Business Name): PAUL G PAGNINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 BROAD ST STE 120
SAN LUIS OBISPO CA
93401-8722
US

IV. Provider business mailing address

225 PRADO RD STE D
SAN LUIS OBISPO CA
93401-7363
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-9209
  • Fax: 805-682-0519
Mailing address:
  • Phone: 805-786-2500
  • Fax: 805-781-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG85253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number318449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: