Healthcare Provider Details

I. General information

NPI: 1851533798
Provider Name (Legal Business Name): COUNTY OF SAN LUIS OBISPO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 TORO ST
SAN LUIS OBISPO CA
93401-3329
US

IV. Provider business mailing address

1103 TORO ST
SAN LUIS OBISPO CA
93401-3329
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4700
  • Fax: 805-781-1273
Mailing address:
  • Phone: 805-781-4700
  • Fax: 805-781-1273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MIRAMON
Title or Position: CHIEF FISCAL OFFICER BEHAVIORAL HEA
Credential:
Phone: 805-788-2932