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Organization
COUNTY OF SAN LUIS OBISPO
Active
Organization
COUNTY OF SAN LUIS OBISPO
Active
Other names
San Luis Obispo County Mental Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
M. DAISY ILANO M.D. (MEDICAL DIRECTOR)
(805) 781-4700
Entity
Organization
Contact information
Practice address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4700
(805) 781-1273
Mailing address
2178 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4535
(805) 781-4700
(805) 781-1273
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4000
—
CA
Enumeration date
10/06/2005
Last updated
08/22/2013
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