Provider Demographics
NPI:1699479808
Name:ADVANCED OBGYN
Entity type:Organization
Organization Name:ADVANCED OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPALDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-773-3060
Mailing Address - Street 1:2 JAMES WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-4974
Mailing Address - Country:US
Mailing Address - Phone:805-773-3060
Mailing Address - Fax:805-269-0026
Practice Address - Street 1:5750 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4252
Practice Address - Country:US
Practice Address - Phone:805-461-3010
Practice Address - Fax:805-461-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty