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General NPI Number Information
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NPI Number | 1609946854
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Entity Type | Organization
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Legal Business Name | UNITED CEREBRAL PALSY
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3620 SACRAMENTO DR SUITE 201
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7215
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Country | US
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Telephone | 805-541-8747
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Fax | 805-543-2045
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Provider Business Mailing Address
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Address Line | 3620 SACRAMENTO DRIVE SUITE 201
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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 | 805-541-8747
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Fax | 805-543-2045
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK SHAFFER
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Credential |
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Telephone | 805-541-8747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347B00000X
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Taxonomy Name | Bus
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License Number |
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License Number State | CA
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