Healthcare Provider Details

I. General information

NPI: 1649037029
Provider Name (Legal Business Name): ANNE MARTIN FREDERICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

215 CANON DR
SANTA BARBARA CA
93105-2638
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7111
  • Fax:
Mailing address:
  • Phone: 805-708-1291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95029319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: