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General NPI Number Information
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NPI Number | 1417903337
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Entity Type | Individual
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Provider Name | NICK LADDHAPHOL GUNASAYAN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 862 MEINECKE AVE STE 204
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-3703
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Country | US
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Telephone | 805-540-5770
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Fax | 888-851-4755
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Provider Business Mailing Address
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Address Line | PO BOX 759
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City | GROVER BEACH
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State | CA
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Zip | 93483-0759
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Country | US
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Telephone | 805-712-6867
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Fax | 888-851-4755
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4414
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License Number State | CA
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