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General NPI Number Information
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NPI Number | 1043328016
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Entity Type | Individual
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Provider Name | LEE J PIATEK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 1500 PALM ST STE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2998
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Country | US
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Telephone | 805-542-9678
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Fax |
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Provider Business Mailing Address
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Address Line | 3405 STUDIO DR
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City | CAYUCOS
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State | CA
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Zip | 93430-1937
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Country | US
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Telephone | 805-995-1873
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Fax |
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | G28265
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License Number State | CA
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