Provider Demographics
NPI:1245637123
Name:UROLOGY ASSOCIATES OF SAN LUIS OBISPO
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF SAN LUIS OBISPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSIENSS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERILYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-786-2500
Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7386
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52086363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty