| Pismo Family Practice | |
|
575 Price St Suite 101 Pismo Beach CA 93449-2553 | |
| (805) 773-0707 | |
| (805) 773-2051 |
| Full Name | Pismo Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 575 Price St, Pismo Beach, California |
| Authorized Official Name and Position | Wendy Eve Weiss (PRESIDENT) |
| Authorized Official Contact | 8057730707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pismo Family Practice 575 Price St Suite 101 Pismo Beach CA 93449-2553 Ph: (805) 773-0707 | Pismo Family Practice 575 Price St Suite 101 Pismo Beach CA 93449-2553 Ph: (805) 773-0707 |
| NPI Number | 1497746473 |
|---|---|
| Provider Enumeration Date | 10/31/2005 |
| Last Update Date | 01/25/2016 |
| Medicare PECOS PAC ID | 5597709360 |
|---|---|
| Medicare Enrollment ID | O20091124000026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497746473 | NPI | - | NPPES |
| C1962153 | Other | CA | STATE CORPORATION NUMBER |
| ZZZ48888Z | Other | CA | BLUE SHIELD GROUP NUMBER |
| GR0080750 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A0436 (California) | Primary |
| Provider Name | Suzan H Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447238894 PECOS PAC ID: 3375574551 Enrollment ID: I20050826000846 |
| Provider Name | Wendy E Weiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609867738 PECOS PAC ID: 8123062999 Enrollment ID: I20091124000023 |
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