Healthcare Provider Details

I. General information

NPI: 1700543253
Provider Name (Legal Business Name): DR. MEHRDAD NAMAVARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 CAMINO DE VIDA APT B
SANTA BARBARA CA
93111-2225
US

IV. Provider business mailing address

192 CAMINO DE VIDA APT B
SANTA BARBARA CA
93111-2225
US

V. Phone/Fax

Practice location:
  • Phone: 805-453-5817
  • Fax:
Mailing address:
  • Phone: 805-453-5817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: