Healthcare Provider Details

I. General information

NPI: 1225020571
Provider Name (Legal Business Name): JULIE A CHACKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 275
GOLETA CA
93111-2472
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-4230
  • Fax: 805-225-6401
Mailing address:
  • Phone: 805-879-4230
  • Fax: 805-225-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA69285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: