Organization
SAN LUIS DIAGNOSTIC MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAIL L. ROBERTS (EXECUTIVE DIRECTOR)
(805) 542-9700
Entity
Organization
Contact information
Practice address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
(805) 542-0584
Mailing address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
(805) 542-0584
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0088380
—
CA
01
—
ZZZ55471Z
BLUE SHIELD ID NUMBER
CA
Enumeration date
01/25/2007
Last updated
08/22/2020
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