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General NPI Number Information
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NPI Number | 1659745974
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Entity Type | Organization
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Legal Business Name | HP CONTINGENT
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Dates
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Enumeration Date | 11/24/2015
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Last Update Date | 11/24/2015
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Provider Practice Location Address
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Address Line | 35 CASA ST SUITE 370
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1818
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Country | US
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Telephone | 805-900-0741
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Fax | 805-221-6135
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Provider Business Mailing Address
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Address Line | 3599 SUELDO ST SUITE 110
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7386
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Country | US
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Telephone | 805-900-0741
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Fax | 805-221-6135
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LISA M GLEASON
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Credential | M.D.
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Telephone | 310-499-8365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A108043
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License Number State | CA
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