Healthcare Provider Details

I. General information

NPI: 1871768150
Provider Name (Legal Business Name): NICK L. GUNASAYAN, D.P.M., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 MEINECKE AVE STE #204
SAN LUIS OBISPO CA
93405-1721
US

IV. Provider business mailing address

1310 LAS TABLAS RD 205
TEMPLETON CA
93465-9737
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5797150001
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE4414
License Number StateCA

VIII. Authorized Official

Name: NICK L GUNASAYAN
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 805-540-5770