PISMO FAMILY PRACTICE MEDICAL CORPORATION A CA PROF MEDICAL CORP (NPI# 1497746473) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497746473 |
| Entity Type | Organization |
| Organization Name | PISMO FAMILY PRACTICE MEDICAL CORPORATION A CA PROF MEDICAL CORP |
| Other Organization Name | PISMO FAMILY PRACTICE |
| Practice Address |
575 Price St Suite 101 Pismo Beach CA 93449-2553 |
| Practice Telephone | 8057730707 |
| Practice Fax Number | 8057732051 |
| Mailing Telephone | 8057730707 |
| Mailing Fax Number | 8057732051 |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-01-25 |
| Authorized Official Name | DR. WENDY EVE WEISS (PRESIDENT) |
| Authorized Official Telephone | 8057730707 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 20A0436 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0080750 | 05 | |
| CA | STATE CORPORATION NUMBER | C1962153 | 01 |
| CA | BLUE SHIELD GROUP NUMBER | ZZZ48888Z | 01 |
| Other Name | Type Code |
|---|---|
| Pismo Family Practice | Doing Business As Name - Organization |
| Street Address |
575 PRICE ST SUITE 101 |
| City | PISMO BEACH |
| State | CA |
| Zip Code | 93449-2553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609867738 | Wendy Eve Weiss | Family Medicine | 575 Price St, Suite 101, Pismo Beach, CA 93449-2553 | 2005-10-28 |
| 1467731430 | Lucille Amelia Whitaker | Nurse Practitioner | 575 Price St, Suite 313, Pismo Beach, CA 93449-2553 | 2011-08-09 |
| 1699739227 | Kimen M Colgan | Physician Assistant | 575 Price St, Suite101, Pismo Beach, CA 93449-2553 | 2006-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831688795 | Kristyn Collins | Psychologist | 130 James Way, #150, Pismo Beach, CA 93449 | 2018-05-07 |
| 1245750140 | Judy Burke Morabito | Pedorthist | 801 Dolliver Street, Pismo Beach, CA 93449 | 2017-06-21 |
| 1295274413 | The San Luis Obispo Hearing Center, Inc | Specialist | 901 Oak Park Blvd Suite 202, Pismo Beach, CA 93449 | 2017-02-21 |
| 1649713645 | Sarah Victoria Stroemel | Counselor | 172 Stimson Ave, #3, Pismo Beach, CA 93449 | 2016-11-22 |
| 1497133631 | Byron N Collier | Podiatrist | 911 Oak Park Blvd Ste 106, Pismo Beach, CA 93449 | 2015-05-07 |
| 1982973319 | Mariana Dintyala | Nurse Practitioner | Avery Healthcare Sevices, 230 Coral Ct, Pismo Beach, CA 93449 | 2011-12-13 |
| 1538444575 | Chelsea Hunter | Student in an Organized Health Care Education/Training Program | 448 Foothill Rd, Pismo Beach, CA 93449 | 2011-10-20 |
| 1952621492 | Briana Leigh Schiro | Counselor | 314 El Portal Dr., Suite 100, Pismo Beach, CA 93449 | 2010-06-07 |
| 1134365315 | Robert Lee Hix | Licensed Psychiatric Technician | 201 Five Cities Dr., 123, Pismo Beach, CA 93449 | 2008-12-18 |
| 1689886764 | Active Physical Therapy Inc | Physical Therapist | 1851 Shell Beach Rd, Suite B, Shell Beach, CA 93449 | 2007-05-03 |
| Find all providers in zip 93449 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912128802 | Antoinette Carmen San Bartolome | Family Medicine | 901 Oak Park Boulevard, Suite 101, Pismo Beach, CA 93449-3409 | 2007-05-01 |
| 1124133863 | Scott Hamilton Davis | Family Medicine | 901 Oak Park Blvd Ste 101, Pismo Beach, CA 93449-3409 | 2006-08-21 |
| 1518996412 | Megan M Malzone | Family Medicine | 931 Oak Park Blvd Ste 101, Pismo Beach, CA 93449-3403 | 2006-07-02 |
| 1376510529 | Frederick W. Thom | Family Medicine | 877 Oak Park Blvd., Med Plus Medical Center, Pismo Beach, CA 93449 | 2006-03-07 |
| 1699758565 | Ventana Health and Medical Center | Family Medicine | 901 Oak Park Blvd, Suite 101, Pismo Beach, CA 93449-3216 | 2005-11-23 |
| 1609867738 | Wendy Eve Weiss | Family Medicine | 575 Price St, Suite 101, Pismo Beach, CA 93449-2553 | 2005-10-28 |
| 1598769929 | Joseph A. Cruz | Family Medicine | 2 James Way, Suite 209, Pismo Beach, CA 93449-4973 | 2005-06-13 |
| 1598125213 | Sara A. Moorehouse | Family Medicine | 901 Oak Park Blvd Ste 101, Pismo Beach, CA 93449-3409 | 2016-02-24 |
| 1003229352 | Terry Chen | Family Medicine | 2 James Way Ste 209, Pismo Beach, CA 93449-4976 | 2014-06-04 |
| 1053742528 | Coastal Village Primary Care, A Medical Group | Family Medicine | 2 James Way, Ste 209, Pismo Beach, CA 93449-4976 | 2013-12-09 |
| Find all providers in PISMO BEACH | ||||
| City | PISMO BEACH |
| Zip Code | 93449 |
Please comment or provide details below to improve the information on PISMO FAMILY PRACTICE MEDICAL CORPORATION A CA PROF MEDICAL CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.