Healthcare Provider Details

I. General information

NPI: 1679629067
Provider Name (Legal Business Name): MARK BRUNO KOFLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 CALLE REAL
SANTA BARBARA CA
93110-1002
US

IV. Provider business mailing address

935 COYOTE RD
SANTA BARBARA CA
93108-1018
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5190
  • Fax: 805-681-5316
Mailing address:
  • Phone: 805-969-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA 30871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: