1063438232 NPI number — SANTA BARBARA NEIGHBORHOOD CLINICS

Table of content: (NPI 1063438232)

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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