Healthcare Provider Details

I. General information

NPI: 1023843406
Provider Name (Legal Business Name): KEILA SARAI MAZARIEGOS ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 REFUGIO RD
GOLETA CA
93117-9778
US

IV. Provider business mailing address

719 W PEDREGOSA ST
SANTA BARBARA CA
93101-4010
US

V. Phone/Fax

Practice location:
  • Phone: 805-243-0199
  • Fax:
Mailing address:
  • Phone: 805-451-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100538
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number100538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: