Healthcare Provider Details

I. General information

NPI: 1639149255
Provider Name (Legal Business Name): COLD SPRINGS MEDICAL SURGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 DE LA VINA ST SUITE 102
SANTA BARBARA CA
93105
US

IV. Provider business mailing address

2323 DE LA VINA ST SUITE 102
SANTA BARBARA CA
93105
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-5065
  • Fax: 805-682-5921
Mailing address:
  • Phone: 805-682-5065
  • Fax: 805-682-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954