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11549 Los Osos Valley Rd Ste 103 San Luis Obispo CA 93405-6457 | |
| (805) 235-7792 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 11549 Los Osos Valley Rd Ste 103, San Luis Obispo, California |
| Authorized Official Name and Position | Gino Anthony Memoli (CEO) |
| Authorized Official Contact | 8052357792 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
305 Leeward Ave Pismo Beach CA 93449-2121 Ph: (805) 235-7792 | 11549 Los Osos Valley Rd Ste 103 San Luis Obispo CA 93405-6457 Ph: (805) 235-7792 |
| NPI Number | 1730947441 |
|---|---|
| Provider Enumeration Date | 03/07/2024 |
| Last Update Date | 05/14/2024 |
| Certification Date | 05/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730947441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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