Healthcare Provider Details

I. General information

NPI: 1386664134
Provider Name (Legal Business Name): PANANGATTUR NANJAPPA RAMALINGAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N R ST
LOMPOC CA
93436-5226
US

IV. Provider business mailing address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-6400
  • Fax: 805-737-6430
Mailing address:
  • Phone: 805-681-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA26409
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00A264090
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 2
IdentifierA26409
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerMED LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: