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NPI Code Detail

MEDICARE: KEN STARR MD WELLNESS GROUP

MEDICARE: KEN STARR MD WELLNESS GROUP
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1598195810
Entity Type Code : Organization
Provider Name (Legal Business Name) : KEN STARR MD WELLNESS GROUP
Provider Business Mailing Address
First Line : 107 NELSON ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420
Country : US
Telephone Number : 626-797-9977
Fax Number : 626-844-2977
Provider Business Practice Location Address
First Line : 107 NELSON ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420-3318
Country : US
Telephone Number : 626-797-9977
Fax Number : 626-844-2977
Authorized Official
Title or Position : OWNER
Name : KEN STARR
Credential :
Telephone Number : 626-797-9977
Provider Enumeration Date : 11/22/2013
Last Update Date : 07/19/2017

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