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Organization
SAN LUIS HOSPITALISTS A MEDICAL CORPORATION
Active
Organization
SAN LUIS HOSPITALISTS A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA KELLER (ADMINISTRATOR)
(805) 503-8422
Entity
Organization
Contact information
Practice address
1911 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4197
(805) 543-5353
(805) 542-6661
Mailing address
PO BOX 1464, SAN LUIS OBISPO, CA 93406-1464
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1218
CMSP PROVIDER NUMBER
CA
01
—
ZZZ56478Y
BLUE SHIELD GROUP NUMBER 2 (1911 JOHNSON)
CA
Enumeration date
11/17/2008
Last updated
11/09/2022
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