1194870220 NPI number — DR. RAFAEL SOLLESA VICTORIA M.D.

Table of content: MIREYA GUTIERREZ LCSW (NPI 1457940132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194870220 NPI number — DR. RAFAEL SOLLESA VICTORIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICTORIA
Provider First Name:
RAFAEL
Provider Middle Name:
SOLLESA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1194870220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62106
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:
93160-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-566-5080
Provider Business Mailing Address Fax Number:
805-566-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4806 CARPINTERIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARPINTERIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93013-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-566-5080
Provider Business Practice Location Address Fax Number:
805-566-5007
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A52387 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: A52387 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: A52387 . This is a "PHYSICIAN'S LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A523870 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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