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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