Healthcare Provider Details

I. General information

NPI: 1013480128
Provider Name (Legal Business Name): SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA BARBARA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COFFEE RD BLDG 5
MODESTO CA
95355-4228
US

IV. Provider business mailing address

218 N I ST
LOMPOC CA
93436-0909
US

V. Phone/Fax

Practice location:
  • Phone: 805-264-3388
  • Fax:
Mailing address:
  • Phone: 805-264-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY DAMATO
Title or Position: CONTRACT MANAGER
Credential:
Phone: 805-264-3388