Healthcare Provider Details

I. General information

NPI: 1093903254
Provider Name (Legal Business Name): FRED J RAZO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1399
US

IV. Provider business mailing address

4400 CATHEDRAL OAKS RD
SANTA BARBARA CA
93110-1042
US

V. Phone/Fax

Practice location:
  • Phone: 805-884-1600
  • Fax:
Mailing address:
  • Phone: 805-964-4710
  • Fax: 805-967-0088

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: