Full Name | |
---|---|
Speciality | Clinic/center - Community Health |
Location | 150 Tejas Pl, Nipomo, California |
Authorized Official Name and Position | Barbara A Allen (BUSINESS OFFICE MANAGER) |
Authorized Official Contact | 8053618014 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
2050 S Blosser Rd Santa Maria CA 93458-7310 Ph: (805) 361-8014 | 150 Tejas Pl Nipomo CA 93444-9123 Ph: (805) 270-1807 |
NPI Number | 1952390254 |
---|---|
Provider Enumeration Date | 10/19/2005 |
Last Update Date | 03/07/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952390254 | NPI | - | NPPES |
PHA46798 | Medicaid | CA | |
PHY46798 | Other | CA | STATE RX LICENSE NUMBER |
5613624 | Other | CA | NCPDP NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | PHY46798 (California) | Secondary |
261QC1500X | Clinic/center - Community Health | (California) | Primary |