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Organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO
Active
Organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF SAN LUIS OBISPO
Active
Parent organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA, INC.
Authorized official
DEVONNA M. KAJI M.D. (PRESIDENT & MEDICAL DIRECTOR)
(559) 353-5700
Entity
Organization
Contact information
Practice address
1010 MURRAY AVE, SAN LUIS OBISPO, CA 93405-1806
(805) 546-7766
(805) 546-7932
Mailing address
9300 VALLEY CHILDRENS PL, MADERA, CA 93636-8761
(559) 353-5700
(559) 353-5708
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013968296
GROUP NPI
CA
05
—
GR0078680
—
CA
01
—
ZZZ13884Z
MEDICARE GROUP
CA
Enumeration date
04/12/2010
Last updated
06/28/2013
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