Healthcare Provider Details

I. General information

NPI: 1952452518
Provider Name (Legal Business Name): IRIS CASTANEDA- VAN WYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 ANACAPA ST SUITE 1
SANTA BARBARA CA
93101-1929
US

IV. Provider business mailing address

1532 ANACAPA ST SUITE 1
SANTA BARBARA CA
93101-1929
US

V. Phone/Fax

Practice location:
  • Phone: 805-892-4141
  • Fax: 805-832-6433
Mailing address:
  • Phone: 805-892-4141
  • Fax: 805-832-6433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA71051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: