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General NPI Number Information
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NPI Number | 1023513009
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Entity Type | Individual
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Provider Name | NICHOLAS PLACONE
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST STE 230
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401
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Country | US
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Telephone | 805-434-5530
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Fax | 805-434-0023
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Provider Business Mailing Address
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Address Line | 1551 BISHOP ST STE 230
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4661
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Country | US
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Telephone | 805-434-5530
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Fax | 805-434-0023
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A164390
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License Number State | CA
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