Individual
MR. ERNEST DANIEL MORENO DYTIAPCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1551 BISHOP ST STE 110, SAN LUIS OBISPO, CA 93401
(208) 422-1314
(208) 422-1536
Mailing address
9161 SEVILLE LN, ATASCADERO, CA 93422
(986) 200-8202
(626) 593-4751
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MRM-1270
ID
207RN0300X
Nephrology Physician
Primary
A136945
CA
207RN0300X
Nephrology Physician
M-12535
ID
Other
Enumeration date
07/16/2011
Last updated
06/02/2020
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