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General NPI Number Information
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NPI Number | 1871768150
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Entity Type | Organization
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Legal Business Name | NICK L. GUNASAYAN, D.P.M., INC
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 862 MEINECKE AVE STE #204
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1721
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Country | US
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Telephone | 805-540-5770
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Fax | 888-851-4755
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Provider Business Mailing Address
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Address Line | 1310 LAS TABLAS RD 205
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City | TEMPLETON
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State | CA
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Zip | 93465-9737
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Country | US
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Telephone | 805-540-5770
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Fax | 888-851-4755
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Authorized Official
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Title or Position | PODIATRIST
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Name | NICK L GUNASAYAN
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Credential | D.P.M.
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Telephone | 805-540-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | E4414
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 5797150001
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License Number State | CA
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