Active NPI
Steven Gastelum
- Licensed Psychiatric Technician
- San Luis Obispo, CA
National Provider Identifier
1487004149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT 30628
- Practice address
- 2178 Johnson Ave
San Luis Obispo, CA 93401-4535 - Phone
- (805) 781-4712
- Fax
- (805) 781-4145
- NPI assigned
- Jun 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT 30628 | CA | Primary |
Addresses
Primary practice location
2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Mailing address
8595 San Andres Ave.
Atascadero, CA 93422
Phone (805) 462-2809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 30628 | CA | MD | Licensed Psychiatric Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1487004149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8595 SAN ANDRES AVE.",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "93422",
"telephone_number": "805-462-2809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2178 JOHNSON AVE",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014535",
"telephone_number": "805-781-4712",
"fax_number": "805-781-4145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GASTELUM",
"first_name": "STEVEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-14",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT 30628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.