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General NPI Number Information
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NPI Number | 1932656337
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Entity Type | Organization
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Legal Business Name | PHILNLN, INC.
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 7619 MORRO RD
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City | ATASCADERO
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State | CA
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Zip | 93422-4433
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Country | US
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Telephone | 805-461-9192
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Fax | 805-461-5802
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Provider Business Mailing Address
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Address Line | 10 SANTA ROSA ST STE 201
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-5825
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Country | US
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Telephone | 805-786-4878
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Fax | 805-597-8356
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. PHILIP JOSEPH CITEK
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Credential | MD
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Telephone | 805-909-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A44775
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A47889
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A47889
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License Number State | CA
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