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525 N Thompson Ave Nipomo CA 93444-9086 | |
(805) 781-4753 | |
(805) 781-1227 |
Full Name | |
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Speciality | Clinic/center |
Location | 525 N Thompson Ave, Nipomo, California |
Authorized Official Name and Position | Starlene M Graber (DIVISION MANAGER) |
Authorized Official Contact | 8057814753 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2180 Johnson Ave San Luis Obispo CA 93401-4513 Ph: (805) 781-4753 | 525 N Thompson Ave Nipomo CA 93444-9086 Ph: (805) 781-4753 |
NPI Number | 1639411440 |
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Provider Enumeration Date | 03/19/2013 |
Last Update Date | 03/31/2014 |
Identifier | Type | State | Issuer |
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1639411440 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |