Healthcare Provider Details

I. General information

NPI: 1740148675
Provider Name (Legal Business Name): CARLY VISGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MICHELTORENA ST STE A
SANTA BARBARA CA
93103-4211
US

IV. Provider business mailing address

3 SCENIC TERRAIN AVE
HENDERSON NV
89011-3166
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-1648
  • Fax:
Mailing address:
  • Phone: 951-219-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: