Provider Demographics
NPI:1326040718
Name:WOMENS HEALTHCARE SPECIALISTS OF SAN LUIS OBISPO INC
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE SPECIALISTS OF SAN LUIS OBISPO INC
Other - Org Name:WOMENS HEALTHCARE SPECIALISTS MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:I
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-544-4883
Mailing Address - Street 1:184 CASA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1804
Mailing Address - Country:US
Mailing Address - Phone:805-544-4883
Mailing Address - Fax:805-542-0827
Practice Address - Street 1:184 CASA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1804
Practice Address - Country:US
Practice Address - Phone:805-544-4883
Practice Address - Fax:805-542-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE052094207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP 25071OtherFICTITIOUS NAME PERMIT #
CAZZZ52948ZOtherBLUE SHIELD GROUP PIN
W10347Medicare PIN