Healthcare Provider Details

I. General information

NPI: 1962438341
Provider Name (Legal Business Name): MARK WIENPAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 N FAIRVIEW AVE STE 101
GOLETA CA
93117-6284
US

IV. Provider business mailing address

319 N MILPAS ST
SANTA BARBARA CA
93103-3262
US

V. Phone/Fax

Practice location:
  • Phone: 805-898-0355
  • Fax: 805-682-6933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23375
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG88817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: