MEDICARE: MRS. BETHANY L.E. AURIOLES LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	167G00000X	Licensed Psychiatric Technician	PT31188	CA

General Provider Information

NPI Number	:	1215084462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY L.E. AURIOLES LPT

Provider Business Mailing Address
First Line	:	117 W TUNNELL ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-4037
Country	:	US
Telephone Number	:	805-739-8670
Fax Number	:	805-739-8671

Provider Business Practice Location Address
First Line	:	2975 MCMILLAN AVE STE 164
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6768
Country	:	US
Telephone Number	:	805-439-4890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	03/13/2024

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