CALIFORNIA POLYTECHNIC STATE UNIVERSITY AT SAN LUIS OBISPO (NPI# 1902086150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902086150 |
| Entity Type | Organization |
| Organization Name | CALIFORNIA POLYTECHNIC STATE UNIVERSITY AT SAN LUIS OBISPO |
| Practice Address |
1 Grand Ave San Luis Obispo CA 93407-9000 |
| Practice Telephone | 8057561211 |
| Mailing Telephone | 8057561211 |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2008-08-14 |
| Authorized Official Name | DR. MARTIN BRAGG (DIRECTOR) |
| Authorized Official Telephone | 8057565278 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | RN389651 | CA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750442653 | California Polytechnic State University At San Luis Obispo | Clinic/Center | Cal Poly Health Services, Grand Ave., San Luis Obispo, CA 93407 | 2006-12-13 |
| Street Address |
1 GRAND AVE |
| City | SAN LUIS OBISPO |
| State | CA |
| Zip Code | 93407-9000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972561728 | Keri Ann Eichenberger | Specialist/Technologist | 1 Grand Ave, Cp Athletics, San Luis Obispo, CA 93401 | 2006-05-02 |
| 1003300153 | Jay Bettergarcia | Psychologist | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2018-06-20 |
| 1427427749 | Carol Anne Freeman | Nurse Practitioner | 1 Grand Ave, Cal Poly Health Services, San Luis Obispo, CA 93410-9001 | 2015-09-16 |
| 1093946287 | Kevin Mccarthy | General Practice | 1 Grand Ave, San Luis Obispo, CA 93407-0210 | 2009-08-05 |
| 1184854598 | Richard V Ascoli | Family Medicine | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2009-07-20 |
| 1942464920 | June Gelling | Pharmacist | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2008-07-18 |
| 1356548051 | Valerie Veronica Monge | Physician Assistant | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2007-06-27 |
| 1902928542 | Raechel Nicole Cunningham | Specialist/Technologist | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2007-04-04 |
| 1255456901 | Paul Eric Gabrielson | Specialist/Technologist | 1 Grand Ave, Athletics, San Luis Obispo, CA 93407-9000 | 2007-03-20 |
| 1558485896 | California Polytechnic State University | Specialist/Technologist | 1 Grand Ave, San Luis Obispo, CA 93407-9000 | 2007-03-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730244377 | Marilyn Jane Pieters | Nurse Practitioner | Cal Poly State University Student Health Services, San Luis Obispo, CA 93407 | 2006-12-26 |
| 1750442653 | California Polytechnic State University At San Luis Obispo | Clinic/Center | Cal Poly Health Services, Grand Ave., San Luis Obispo, CA 93407 | 2006-12-13 |
| 1710065461 | Marina E Perez | Nurse Practitioner | 1 Grand Ave., Cal Poly Health Services, San Luis Obispo, CA 93407 | 2006-11-01 |
| 1447435912 | Cal Poly Health Services | Clinic/Center | 1 Grand Ave Building 27, Cal Poly State University, San Luis Obispo, CA 93407-0000 | 2008-01-03 |
| 1275739245 | Nancy J Walden | Nurse Practitioner | Cal Poly State Health Center, 1 Grand Ave Building 27, San Luis Obispo, CA 93407-0210 | 2007-06-26 |
| 1558475699 | Mark Mason Haley | Physician Assistant | One Grand Ave, San Luis Obispo, CA 93407-0210 | 2006-08-18 |
| 1417194408 | Norman Brooks Smith | Family Medicine | 1 Grand Ave., Cal Poly Health Services, San Luis Obispo, CA 93407-0210 | 2009-01-13 |
| 1720140288 | Cal Poly Health Services | Clinic/Center | Health Services, California Polytechnic State University, San Luis Obispo, CA 93407-0210 | 2006-12-14 |
| 1750450680 | David Lloyd Harris | Internal Medicine | Health Services, California Polytechnic State University, San Luis Obispo, CA 93407-0210 | 2006-11-07 |
| 1578694675 | Student Health Service Pharmacy | Pharmacy | 1 Grand Ave Bldg 27, Health Center, San Luis Obispo, CA 93407-9000 | 2007-03-08 |
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| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619219516 | County of San Luis Obispo | Clinic/Center | 11950 Los Osos Valley Rd, Room: Counselor D, San Luis Obispo, CA 93405-6861 | 2013-03-19 |
| 1447435912 | Cal Poly Health Services | Clinic/Center | 1 Grand Ave Building 27, Cal Poly State University, San Luis Obispo, CA 93407-0000 | 2008-01-03 |
| 1750442653 | California Polytechnic State University At San Luis Obispo | Clinic/Center | Cal Poly Health Services, Grand Ave., San Luis Obispo, CA 93407 | 2006-12-13 |
| 1447321120 | Community Action Partnership of San Luis Obispo County, Inc. | Clinic/Center | 705 Grand Ave, San Luis Obispo, CA 93401-2639 | 2006-11-13 |
| 1942292701 | Amy D Goodman | Clinic/Center | 1375 Oakwood Ct, San Luis Obispo, CA 93401-5918 | 2005-08-18 |
| 1750623229 | County of San Luis Obispo Drug and Alcohol Services | Clinic/Center | 277 South St Ste T, San Luis Obispo, CA 93401 | 2013-03-22 |
| 1396029435 | Spurlock Chiropractic Spinal Decompression Clinic, Inc | Clinic/Center | 1318 Garden St, San Luis Obispo, CA 93401-3916 | 2011-10-07 |
| 1326258203 | County of San Luis Obispo Drug and Alcohol Services | Clinic/Center | 2180 Johnson Ave, San Luis Obispo, CA 93401 | 2007-05-22 |
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| City | SAN LUIS OBISPO |
| Zip Code | 93407 |
Please comment or provide details below to improve the information on CALIFORNIA POLYTECHNIC STATE UNIVERSITY AT SAN LUIS OBISPO.
| 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.