Healthcare Provider Details

I. General information

NPI: 1093075509
Provider Name (Legal Business Name): MANI YAHYAVI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

IV. Provider business mailing address

689 CATANIA WAY
SANTA BARBARA CA
93105-4416
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-6786
  • Fax: 805-965-3797
Mailing address:
  • Phone: 805-708-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: