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1499 San Luis Dr San Luis Obispo CA 93401-3060 | |
| (805) 596-4040 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1499 San Luis 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 | 1499 San Luis Dr San Luis Obispo CA 93401-3060 Ph: (805) 596-4040 |
| NPI Number | 1134648603 |
|---|---|
| Provider Enumeration Date | 09/15/2017 |
| Last Update Date | 09/15/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134648603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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