Healthcare Provider Details

I. General information

NPI: 1851063218
Provider Name (Legal Business Name): DAVID BUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HITCHCOCK WAY
SANTA BARBARA CA
93105-3101
US

IV. Provider business mailing address

PO BOX 276004
SACRAMENTO CA
95827-6004
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-6211
  • Fax:
Mailing address:
  • Phone: 800-478-8837
  • Fax: 916-739-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A23865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: