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Organization
COUNTY OF SAN LUIS OBISPO
Active
Organization
COUNTY OF SAN LUIS OBISPO
Active
Other names
Martha's Place
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
2925 MCMILLAN AVE STE 108, SAN LUIS OBISPO, CA 93401-6765
(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
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4083
—
CA
Enumeration date
03/18/2010
Last updated
08/22/2013
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