St Michael Nephrology, PC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

ST MICHAEL NEPHROLOGY, PC

Practice address

620 California Blvd BLDG B
Suite P1
San Luis Obispo, CA 93401-2541

Phone

(805) 792-2274

NPI assigned

Oct 17, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ernest Daniel Moreno Dytiapco, MD

Title

President

Phone

(805) 792-2274

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ernest Daniel Moreno Dytiapco, MD

  • Nephrology Physician
  • San Luis Obispo, CA
  • NPI 1255629846
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1669198206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 CALIFORNIA BLVD BLDG B",
            "address_2": "SUITE P1",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012541",
            "telephone_number": "805-792-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 CALIFORNIA BLVD BLDG B",
            "address_2": "SUITE P1",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012541",
            "telephone_number": "805-792-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MICHAEL NEPHROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-17",
        "last_updated": "2022-10-17",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "DYTIAPCO",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "DANIEL MORENO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-792-2274",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Anne Springer, M.D.
• Spurlock Chiropractic Spinal Decompression Clinic, Inc
• James Madison Spurlock IV, D.C.
• Kanika Srivastava
• Grace St Denis, MS - SLP
• Charles E St. Vincent, P.T.
• Monica Stagg, R.N.
• Shelly Rose Vonk Staley, LMFT 114352
• Elina Marie Stanford
• Lillian June Stanley, MSN FNP-C

• Nephrology Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.