MEDICARE: DR. KIRAN MARIWALLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	C52068	CA
2	207R00000X	Internal Medicine Physician	C52068	CA

General Provider Information

NPI Number	:	1558471433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRAN MARIWALLA MD

Provider Business Mailing Address
First Line	:	PO BOX 62106
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93160-2106
Country	:	US
Telephone Number	:	805-681-7761
Fax Number	:	805-681-1768

Provider Business Practice Location Address
First Line	:	2027 VILLAGE LN
Second Line	:	SUITE 201
City	:	SOLVANG
State	:	CA
Zip	:	93463-2283
Country	:	US
Telephone Number	:	805-688-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/26/2011

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