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General NPI Number Information
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NPI Number | 1508182833
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Entity Type | Organization
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Legal Business Name | SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 1010 MURRAY AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1806
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Country | US
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Telephone | 805-546-7766
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Fax | 805-546-7932
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Provider Business Mailing Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636-8761
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Country | US
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Telephone | 559-353-5700
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Fax | 559-353-5708
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Authorized Official
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Title or Position | PRESIDENT & MEDICAL DIRECTOR
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Name | DEVONNA M. KAJI
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Credential | M.D.
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Telephone | 559-353-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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