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General NPI Number Information
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NPI Number | 1831631001
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PARTNERS - SLO, P.C.
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 84 SANTA ROSA ST A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1812
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Country | US
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Telephone | 805-591-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 84 SANTA ROSA ST A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1812
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Country | US
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Telephone | 805-591-4727
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Fax |
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Authorized Official
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Title or Position | FAMILY PHYSICIAN/ PRESIDENT
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Name | DR. ANDREA ANGELUCCI
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Credential | D.O.
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Telephone | 805-591-4727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20A11012
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License Number State | CA
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