Healthcare Provider Details

I. General information

NPI: 1720316052
Provider Name (Legal Business Name): SANTA MARIA NEONATOLOGY INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

IV. Provider business mailing address

1400 E CHURCH ST
SANTA MARIA CA
93454-5906
US

V. Phone/Fax

Practice location:
  • Phone: 805-547-1255
  • Fax: 805-547-1395
Mailing address:
  • Phone: 805-547-1255
  • Fax: 805-547-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: EDWARD C ALDERETE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-547-1255