Healthcare Provider Details

I. General information

NPI: 1730234352
Provider Name (Legal Business Name): MARIANO REQUENA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W MISSION ST
SANTA BARBARA CA
93101-2820
US

IV. Provider business mailing address

215 W MISSION ST
SANTA BARBARA CA
93101-2820
US

V. Phone/Fax

Practice location:
  • Phone: 805-895-5679
  • Fax:
Mailing address:
  • Phone: 805-253-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: