Healthcare Provider Details

I. General information

NPI: 1194870220
Provider Name (Legal Business Name): RAFAEL SOLLESA VICTORIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4806 CARPINTERIA AVE
CARPINTERIA CA
93013-1935
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-5080
  • Fax: 805-566-5007
Mailing address:
  • Phone: 805-566-5080
  • Fax: 805-566-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52387
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: