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General NPI Number Information
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NPI Number | 1992255947
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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 | 10/13/2016
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Last Update Date | 01/29/2018
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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 | 805-461-5800
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Fax | 805-461-5802
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Provider Business Mailing 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 | 805-461-5800
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Fax | 805-461-5802
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINA KINGSBURY
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Credential |
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Telephone | 805-461-5800
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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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