Provider Information for 1023329315
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AHNA NICOLE BISHOP
Sex: Female
NPI: 1023329315
Last Updated: 2013-05-22
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1023329315 | ||||||||
| Enumeration Date | 2010-07-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 15408 SAN LUIS OBISPO, CA 93406-5408 United States Phone: 559-304-3911 | Fax: | ||||||||
| Primary Practice Address | 784 HIGH ST SAN LUIS OBISPO, CA 93401-5243 United States Phone: 805-540-6500 | Fax:805-540-6501 | ||||||||
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