Healthcare Provider Details

I. General information

NPI: 1649296807
Provider Name (Legal Business Name): SANSUM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W PUEBLO ST
SANTA BARBARA CA
93105-4355
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-1768
  • Fax:
Mailing address:
  • Phone: 805-681-1768
  • Fax:

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: CHAD HINE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 805-681-7709