Provider Demographics
NPI:1831631001
Name:PRIMARY CARE PARTNERS - SLO, P.C.
Entity type:Organization
Organization Name:PRIMARY CARE PARTNERS - SLO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-591-4727
Mailing Address - Street 1:84 SANTA ROSA ST
Mailing Address - Street 2:A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1812
Mailing Address - Country:US
Mailing Address - Phone:805-591-4727
Mailing Address - Fax:
Practice Address - Street 1:84 SANTA ROSA ST
Practice Address - Street 2:A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1812
Practice Address - Country:US
Practice Address - Phone:805-591-4727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11012261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215284096OtherNPI
1861676553OtherNPI
1215150040OtherNPI
1851616106OtherNPI
1861676553OtherNPI