Healthcare Provider Details

I. General information

NPI: 1871989186
Provider Name (Legal Business Name): REGINALD FONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 DE LA VINA ST STE 205
SANTA BARBARA CA
93105-3879
US

IV. Provider business mailing address

2323 DE LA VINA ST STE 205
SANTA BARBARA CA
93105-3879
US

V. Phone/Fax

Practice location:
  • Phone: 805-363-6325
  • Fax:
Mailing address:
  • Phone: 805-363-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA203981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: