Provider Demographics
NPI:1932656337
Name:PHILNLN, INC.
Entity Type:Organization
Organization Name:PHILNLN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CITEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-909-0612
Mailing Address - Street 1:10 SANTA ROSA ST
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5825
Mailing Address - Country:US
Mailing Address - Phone:805-786-4878
Mailing Address - Fax:805-597-8356
Practice Address - Street 1:7619 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4433
Practice Address - Country:US
Practice Address - Phone:805-461-9192
Practice Address - Fax:805-461-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44775207Q00000X
CAA478892081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47889OtherMEDICARE PTAN
CAA47889OtherMEDICARE PTAN