Healthcare Provider Details

I. General information

NPI: 1952561698
Provider Name (Legal Business Name): MICHAEL TRIPLETT BA RDCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WINCHESTER CANYON RD
GOLETA CA
93117-1005
US

IV. Provider business mailing address

401 WINCHESTER CANYON RD
GOLETA CA
93117-1005
US

V. Phone/Fax

Practice location:
  • Phone: 805-680-3784
  • Fax: 805-685-3715
Mailing address:
  • Phone: 805-680-3784
  • Fax: 805-685-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License NumberRDCS 24327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: