| San Luis Primary Care Medical Group, Inc. | |
|
1941 Johnson Ave Suite 203 San Luis Obispo CA 93401-4140 | |
| (805) 546-0780 | |
| (805) 546-0332 |
| Full Name | San Luis Primary Care Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1941 Johnson Ave, San Luis Obispo, California |
| Authorized Official Name and Position | David W. Leece (PRESIDENT) |
| Authorized Official Contact | 8055460780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Luis Primary Care Medical Group, Inc. 1941 Johnson Ave Suite 203 San Luis Obispo CA 93401-4140 Ph: (805) 546-0780 | San Luis Primary Care Medical Group, Inc. 1941 Johnson Ave Suite 203 San Luis Obispo CA 93401-4140 Ph: (805) 546-0780 |
| NPI Number | 1831168772 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 03/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831168772 | NPI | - | NPPES |
| ZZZ00890Z | Other | CA | BLUE SHIELD OF CALIFORNIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C2321370 (California) | Primary |
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