Healthcare Provider Details

I. General information

NPI: 1992431282
Provider Name (Legal Business Name): TRAVIS TROTTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 CLIFF DR
SANTA BARBARA CA
93109-1672
US

IV. Provider business mailing address

1819 CLIFF DR
SANTA BARBARA CA
93109-1672
US

V. Phone/Fax

Practice location:
  • Phone: 805-586-2400
  • Fax:
Mailing address:
  • Phone: 805-586-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: