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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1700128071
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	:	1 HIGH SCHOOL HILL RD
Second Line	:	ROOMS A107,A121,A125,A167,A232
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4189
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	:	03/25/2013
Last Update Date	:	04/02/2014

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Directions to “COUNTY OF SAN LUIS OBISPO ” Practice Location

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