Healthcare Provider Details

I. General information

NPI: 1053364471
Provider Name (Legal Business Name): EDMUND M WROBLEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BATH ST SUITE 201
SANTA BARBARA CA
93105-4351
US

IV. Provider business mailing address

2400 BATH ST SUITE 201
SANTA BARBARA CA
93105-4351
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7707
  • Fax: 805-682-7710
Mailing address:
  • Phone: 805-682-7707
  • Fax: 805-682-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG44723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: