Healthcare Provider Details

I. General information

NPI: 1629716360
Provider Name (Legal Business Name): DOCTORS WITHOUT WALLS-SANTA BARBARA STREET MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MICHELTORENA ST
SANTA BARBARA CA
93101-2503
US

IV. Provider business mailing address

19 E MICHELTORENA ST
SANTA BARBARA CA
93101-2503
US

V. Phone/Fax

Practice location:
  • Phone: 805-455-4234
  • Fax:
Mailing address:
  • Phone: 805-455-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MARGUERITE M SANCHEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-729-6796