MEDICARE: SANTA MARIA FAMILY MEDICINE

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	171W00000X	Contractor	C52263	CA

General Provider Information

NPI Number	:	1639285158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MARIA FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	124 W FESLER ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-4002
Country	:	US
Telephone Number	:	805-928-7881
Fax Number	:	805-928-1931

Provider Business Practice Location Address
First Line	:	124 W FESLER ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-4002
Country	:	US
Telephone Number	:	805-928-7881
Fax Number	:	805-928-1931

Authorized Official
Title or Position	:	OWER
Name	:	FRANCISCO REYNA MENDOZA
Credential	:	M.D.
Telephone Number	:	805-928-7881

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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