Basic Information
| Provider Information | |||||||||
| NPI: | 1124263744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURGUIA | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15408 | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934065408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055406500 | ||||||||
| FaxNumber: | 8055406501 | ||||||||
| Practice Location | |||||||||
| Address1: | 784 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934015243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055406500 | ||||||||
| FaxNumber: | 8055406501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2008 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1689762486 | 01 | CA | CARES CRISIS RESIDENTIAL | OTHER | 9174 | 05 | CA | MEDICAID | 174400000X | 01 | CA | OTHER | OTHER |