Healthcare Provider Details

I. General information

NPI: 1013050814
Provider Name (Legal Business Name): RECOVERY ROAD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 STATE STREET
SANTA BARBARA CA
93101-2520
US

IV. Provider business mailing address

PO BOX 3770
SANTA BARBARA CA
93130-3770
US

V. Phone/Fax

Practice location:
  • Phone: 805-962-7800
  • Fax: 805-962-9002
Mailing address:
  • Phone: 805-962-7800
  • Fax: 805-962-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number959161
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number420034AP
License Number StateCA

VIII. Authorized Official

Name: MRS. WILMA CALDER
Title or Position: BILLING MGR
Credential:
Phone: 707-246-9585