Healthcare Provider Details

I. General information

NPI: 1295718849
Provider Name (Legal Business Name): MED-STOPS MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 MADONNA RD SUITE B
SAN LUIS OBISPO CA
93405-5432
US

IV. Provider business mailing address

283 MADONNA RD SUITE B
SAN LUIS OBISPO CA
93405-5432
US

V. Phone/Fax

Practice location:
  • Phone: 805-549-8880
  • Fax: 805-783-2009
Mailing address:
  • Phone: 805-549-8880
  • Fax: 805-783-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number22211568
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN M. ROBERTS
Title or Position: OWNER
Credential: M.D.
Phone: 805-549-8880