San Luis Primary Care Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C2321370 Issued in CA

Legal business name

SAN LUIS PRIMARY CARE MEDICAL GROUP, INC.

Practice address

1941 Johnson Ave
Suite 203
San Luis Obispo, CA 93401-4140

Phone

(805) 546-0780

Fax

(805) 546-0332

NPI assigned

Mar 14, 2006

Last updated

Mar 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David W. Leece, M.D.NPI 1528037561

Title

President

Phone

(805) 546-0780

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David W. Leece, M.D.

  • Family Medicine Physician
  • San Luis Obispo, CA
  • NPI 1528037561
  NPD (past) Authorized official
• Gayle S Cekada, M.D

  • Internal Medicine Physician
  • San Luis Obispo, CA
  • NPI 1114996055
  NPD (past)
• Corinne Rose Kohlen, R.D.

  • Renal Nutrition Registered Dietitian
  • San Luis Obispo, CA
  • NPI 1952638207
  NPD (past)

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1831168772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE",
            "address_2": "SUITE 203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014140",
            "telephone_number": "805-546-0780",
            "fax_number": "805-546-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE",
            "address_2": "SUITE 203",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014140",
            "telephone_number": "805-546-0780",
            "fax_number": "805-546-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS PRIMARY CARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "LEECE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-546-0780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C2321370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ00890Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Luis Obispo Surgery Center a California Limited Partnership
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc (Movement For Life Physical Therapy)
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc (Movement For Life Physical Therapy)
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc (Movement For Life Physical Therapy)
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc (Movement For Life Physical Therapy)
• Marissa Sanchez Magana
• Mary H Sanchez-Allwein
• Heriberto G Sanchez, PSYCHOLOGIST
• Isabella Anissa Sanchez
• Maricela Sanchez

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.