Healthcare Provider Details

I. General information

NPI: 1457371791
Provider Name (Legal Business Name): WILLIAM NICOL GUDDAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W JUNIPERO ST
SANTA BARBARA CA
93105-4239
US

IV. Provider business mailing address

1150 COAST VILLAGE RD APT 206
SANTA BARBARA CA
93108-2705
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-8844
  • Fax: 805-682-4735
Mailing address:
  • Phone: 805-969-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG63113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: