Healthcare Provider Details

I. General information

NPI: 1366194342
Provider Name (Legal Business Name): MARISA CIPOLLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 DE LA VINA ST STE 303
SANTA BARBARA CA
93105-3876
US

IV. Provider business mailing address

1601 GILLESPIE ST
SANTA BARBARA CA
93101-4767
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-0855
  • Fax:
Mailing address:
  • Phone: 570-447-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95120931
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: