Healthcare Provider Details

I. General information

NPI: 1265091946
Provider Name (Legal Business Name): CHRISTOPHER WENTLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 10/20/2026
Certification Date: 10/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 E CLARK AVE STE 102
ORCUTT CA
93455-7507
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-354-5562
  • Fax: 805-319-8038
Mailing address:
  • Phone: 805-354-5562
  • Fax: 805-319-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: