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SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO NPI 1508182833


NPI Information

NPI: 1508182833
Provider Name: SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO
Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
1010 MURRAY AVE
SAN LUIS OBISPO, CA
ZIP 93405
Phone: (805) 546-7766
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SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO is a pediatrics in San Luis Obispo, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO NPI is 1508182833. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1010 MURRAY AVE
SAN LUIS OBISPO, CA
ZIP 93405-806
Phone: (805) 546-7766
Fax: (805) 546-7932

The provider's authorized official is Devonna M. Kaji .
The authorized official title is President & Medical Director and has the following contact phone number (559) 353-5700.

The enumeration date for this NPI number is 4/12/2010 and was last updated on 6/28/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsCALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0078680MEDICAIDCALIFORNIA
21013968296OTHERCALIFORNIAGROUP NPI
3ZZZ13884ZOTHERCALIFORNIAMEDICARE GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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