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1989 Vincente Dr Bldg A San Luis Obispo CA 93405-0001 | |
| (805) 781-4179 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1989 Vincente Dr, San Luis Obispo, California |
| Authorized Official Name and Position | M. Daisy Ilano (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8057814700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2178 Johnson Ave San Luis Obispo CA 93401-4535 Ph: (805) 781-4700 | 1989 Vincente Dr Bldg A San Luis Obispo CA 93405-0001 Ph: (805) 781-4179 |
| NPI Number | 1396803870 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 04/29/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396803870 | NPI | - | NPPES |
| 4017 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (California) | Primary |
Restorative Partners, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3196 S Higuera St Ste D, San Luis Obispo, CA 93401 Phone: 805-242-1272 | |
County Of San Luis Obispo Drug And Alcohol Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2945 Mcmillan Ave, Ste. 136, San Luis Obispo, CA 93401 Phone: 805-781-4275 | |
The Bauman Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1368 Marsh St, San Luis Obispo, CA 93401 Phone: 805-540-7060 Fax: 805-540-7063 | |