Provider Demographics
NPI:1134512312
Name:NANCY A. PAWLIK, M.D. A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:NANCY A. PAWLIK, M.D. A PROFESSIONAL CORP
Other - Org Name:NANCY A. PAWLIK, M.D. F.A.C.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PAWLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-783-7044
Mailing Address - Street 1:437 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3822
Mailing Address - Country:US
Mailing Address - Phone:805-783-7044
Mailing Address - Fax:805-783-7047
Practice Address - Street 1:437 MARSH ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3822
Practice Address - Country:US
Practice Address - Phone:805-783-7044
Practice Address - Fax:805-783-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54852208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006548520OtherMEDI-CAL
CAG54852Medicare UPIN