1063438232 NPI number — SANTA BARBARA NEIGHBORHOOD CLINICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063438232 NPI number — SANTA BARBARA NEIGHBORHOOD CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANTA BARBARA NEIGHBORHOOD CLINICS
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:
6
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:
1063438232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 N MILPAS ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93103-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-617-7858
Provider Business Mailing Address Fax Number:
805-898-2002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 N MILPAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93103-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-963-1641
Provider Business Practice Location Address Fax Number:
805-962-6616
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FENZI
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
CAMILLO
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
805-617-7850

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  050000113 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050000113 . This is a "COMMUNITY CLINIC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP70114G . This is a "FAMPACT LEGACY NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP70114G . This is a "CDP PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: EAP70114G . This is a "EAPC PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLP 303897 . This is a "DHS LAB REGISTRATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 168904 . This is a "CCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0584453 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLN 1072 . This is a "BOARD OF PHARMACY CLINIC PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC70114G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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