Healthcare Provider Details

I. General information

NPI: 1881967172
Provider Name (Legal Business Name): BRETT ANDREW GIDNEY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W PUEBLO ST SUITE 101
SANTA BARBARA CA
93105-6211
US

IV. Provider business mailing address

504 W PUEBLO ST SUITE 101
SANTA BARBARA CA
93105-6211
US

V. Phone/Fax

Practice location:
  • Phone: 805-845-5305
  • Fax: 805-845-6453
Mailing address:
  • Phone: 805-845-5305
  • Fax: 805-845-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA81336
License Number StateCA

VIII. Authorized Official

Name: DR. BRETT ANDREW GIDNEY
Title or Position: PRESIDENT
Credential: MD
Phone: 805-845-5305