Healthcare Provider Details

I. General information

NPI: 1902490378
Provider Name (Legal Business Name): BRIAN KLASSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

IV. Provider business mailing address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

V. Phone/Fax

Practice location:
  • Phone: 489-080-5439
  • Fax:
Mailing address:
  • Phone: 489-080-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: