1205514510 NPI number — GARY M. WESTBROCK, PHYSICIAN ASSISTANT, INC.

Table of content: MS. GABRIELLE ELANA SLAVIN MA (NPI 1194022780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205514510 NPI number — GARY M. WESTBROCK, PHYSICIAN ASSISTANT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY M. WESTBROCK, PHYSICIAN ASSISTANT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205514510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2603 SILVERWOOD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASO ROBLES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93446-4763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-541-4018
Provider Business Mailing Address Fax Number:
805-543-6271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 TANK FARM RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-7068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-4018
Provider Business Practice Location Address Fax Number:
805-543-6271
Provider Enumeration Date:
07/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WESTBROCK
Authorized Official First Name:
GARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-541-4018

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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