Healthcare Provider Details

I. General information

NPI: 1750307906
Provider Name (Legal Business Name): CHILDREN'S MEDICAL CLINIC OF SANTA BARBARA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E ARRELLAGA ST
SANTA BARBARA CA
93101-2531
US

IV. Provider business mailing address

15 E ARRELLAGA ST
SANTA BARBARA CA
93101-2531
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-1095
  • Fax: 805-965-8905
Mailing address:
  • Phone: 805-965-1095
  • Fax: 805-963-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J KULLIK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 805-965-1095