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General NPI Number Information
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NPI Number | 1811796162
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Entity Type | Organization
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Legal Business Name | PACIFIC SURGERY CENTER OF SAN LUIS OBISPO, LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 4472 BROAD ST STE 150
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7990
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Country | US
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Telephone | 818-348-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 7230 MEDICAL CENTER DR STE 500
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City | WEST HILLS
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State | CA
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Zip | 91307-4024
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Country | US
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Telephone | 818-348-7246
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | KELLIE TUASON
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Credential | RN
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Telephone | 818-348-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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