Healthcare Provider Details

I. General information

NPI: 1134680978
Provider Name (Legal Business Name): JOEL ROBERT HLAVATY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 DE LA VINA ST
SANTA BARBARA CA
93105-3823
US

IV. Provider business mailing address

2051 SOLAR DR STE 150
OXNARD CA
93036-0641
US

V. Phone/Fax

Practice location:
  • Phone: 805-456-8890
  • Fax: 805-485-4088
Mailing address:
  • Phone: 805-456-8890
  • Fax: 805-485-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA207012
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA207012
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.153873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: