Healthcare Provider Details

I. General information

NPI: 1164501649
Provider Name (Legal Business Name): CLAIRE ELIZABETH WISWALL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 205
SANTA BARBARA CA
93105-5313
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-1164
  • Fax: 805-569-1094
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: