1881934594 NPI number — PUEBLO SANTA BARBARA WOMEN'S IMAGING ASSOCIATES, INC

Table of content: (NPI 1881934594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881934594 NPI number — PUEBLO SANTA BARBARA WOMEN'S IMAGING ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUEBLO SANTA BARBARA WOMEN'S IMAGING ASSOCIATES, 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:
SANTA BARBARA WOMEN'S IMAGING CENTER
Provider Other Organization Name Type Code:
3
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:
1881934594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1326
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93102-1326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-682-7984
Provider Business Mailing Address Fax Number:
805-569-2964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-560-8111
Provider Business Practice Location Address Fax Number:
805-560-6900
Provider Enumeration Date:
02/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEUNG
Authorized Official First Name:
WINIFRED
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
805-682-7984

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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