=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487041018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUSTIN HELLMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2015
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 AEROVISTA PL STE 109
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93401-7970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-439-1010
-----------------------------------------------------
Fax | 805-439-1213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 AEROVISTA PL STE 109
-----------------------------------------------------
City | SAN LUIS OBISPO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93401-7970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-439-1010
-----------------------------------------------------
Fax | 805-439-1213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | 147716
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | A147716
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------