1225054414 NPI number — SANTA BARBARA NEIGHBORHOOD CLINICS

Table of content: (NPI 1225054414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225054414 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:
WESTSIDE NEIGHBORHOOD CLINIC
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:
1225054414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/01/2006
NPI Reactivation Date:
02/08/2007

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:
805-963-8880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 W MICHELTORENA 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:
93101-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-963-1546
Provider Business Practice Location Address Fax Number:
805-962-4771
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:  050000091 , 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: 1598942492 . This is a "CPD NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC12002G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168902 . This is a "CCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BCP12002G . This is a "CDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC12002G . This is a "CHDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1407033301 . This is a "FAMPACT NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLN 1074 . This is a "BOARD OF PHARMACY CLINIC PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HAP12002G . This is a "FP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0584453 . This is a "CLIA" 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".




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