Healthcare Provider Details

I. General information

NPI: 1073693297
Provider Name (Legal Business Name): VICTOR ANDREW TACCONELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE # 135
SANTA BARBARA CA
93111-3320
US

IV. Provider business mailing address

5333 HOLLISTER AVE STE 135
SANTA BARBARA CA
93111-3320
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-9311
  • Fax: 805-967-4192
Mailing address:
  • Phone: 805-967-9311
  • Fax: 805-967-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG27913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: