1104958339 NPI number — PLASTIC SURGERY AND HAND SURGERY CLINIC OF SANTA BARBARA, INC

Table of content: TAMMY LYNN KINGSBURY RN (NPI 1881399681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104958339 NPI number — PLASTIC SURGERY AND HAND SURGERY CLINIC OF SANTA BARBARA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLASTIC SURGERY AND HAND SURGERY CLINIC OF SANTA BARBARA, 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:
1104958339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 E ARRELLAGA ST
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:
93103-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-966-2203
Provider Business Mailing Address Fax Number:
805-966-7821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 E ARRELLAGA 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:
93103-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-966-2203
Provider Business Practice Location Address Fax Number:
805-966-7821
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPPLE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
GILBERT
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
805-966-2203

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A21284 , 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)





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