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620 California Blvd Ste J San Luis Obispo CA 93401-2541 | |
| (805) 547-2275 | |
| (805) 547-2279 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 620 California Blvd, San Luis Obispo, California |
| Authorized Official Name and Position | Jeff Koury (CEO) |
| Authorized Official Contact | 7144286842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1541 Florida Ave Ste 200 Modesto CA 95350-4429 Ph: (209) 214-7053 | 620 California Blvd Ste J San Luis Obispo CA 93401-2541 Ph: (805) 547-2275 |
| NPI Number | 1437408119 |
|---|---|
| Provider Enumeration Date | 09/10/2012 |
| Last Update Date | 06/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437408119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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