Healthcare Provider Details

I. General information

NPI: 1427132000
Provider Name (Legal Business Name): NICK L. GUNASAYAN, D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 MEINECKE AVE STE 204
SAN LUIS OBISPO CA
93405-3703
US

IV. Provider business mailing address

PO BOX 759
GROVER BEACH CA
93483-0759
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-5770
  • Fax: 888-851-4755
Mailing address:
  • Phone: 805-712-6867
  • Fax: 888-851-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4414
License Number StateCA

VIII. Authorized Official

Name: PHUONG GUNASAYAN
Title or Position: CFO
Credential:
Phone: 805-712-6867