MEDICARE: SEVEN PEAKS MEDICAL GROUP, INC.

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	207Q00000X	Family Medicine Physician	20A11056	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A11056	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1750547550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVEN PEAKS MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3889 LONG ST STE 201
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7581
Country	:	US
Telephone Number	:	805-548-8877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3889 LONG ST STE 201
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7581
Country	:	US
Telephone Number	:	805-548-8877
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SHAUNA M LYNCH
Credential	:	D.O.
Telephone Number	:	805-548-8877

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	04/09/2014

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