Healthcare Provider Details

I. General information

NPI: 1457663221
Provider Name (Legal Business Name): BRANDON BOESCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-8160
  • Fax: 805-225-6231
Mailing address:
  • Phone: 805-879-8160
  • Fax: 805-225-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A12048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: