Healthcare Provider Details

I. General information

NPI: 1316787377
Provider Name (Legal Business Name): FIGHTING BACK SANTA MARIA VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MILLER ST STE 209
SANTA MARIA CA
93454-5249
US

IV. Provider business mailing address

PO BOX 184
SANTA MARIA CA
93456-0184
US

V. Phone/Fax

Practice location:
  • Phone: 805-720-6220
  • Fax: 805-621-5859
Mailing address:
  • Phone: 805-346-1774
  • Fax: 805-621-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANK EDWIN WEAVER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, MDR
Phone: 805-346-1774