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NPI Code Detail

MEDICARE: COUNTY OF SAN LUIS OBISPO

MEDICARE: COUNTY OF SAN LUIS OBISPO
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1215279781
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF SAN LUIS OBISPO
Provider Business Mailing Address
First Line : 2180 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4513
Country : US
Telephone Number : 805-781-4753
Fax Number : 805-781-1227
Provider Business Practice Location Address
First Line : 812 NIBLICK RD
Second Line :
City : PASO ROBLES
State : CA
Zip : 93446-4858
Country : US
Telephone Number : 805-781-4753
Fax Number : 805-781-1227
Authorized Official
Title or Position : DIVISION MANAGER
Name : DR. STARLENE M GRABER
Credential : PHD, LMFT
Telephone Number : 805-781-4753
Provider Enumeration Date : 03/22/2013
Last Update Date : 03/31/2014

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Directions to “COUNTY OF SAN LUIS OBISPO ” Practice Location

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