Healthcare Provider Details

I. General information

NPI: 1104873603
Provider Name (Legal Business Name): DREW G. KELTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 250
GOLETA CA
93111
US

IV. Provider business mailing address

PO BOX 50706
SANTA BARBARA CA
93150-0706
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-4242
  • Fax: 805-879-4268
Mailing address:
  • Phone: 805-963-3757
  • Fax: 805-564-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG40720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: