Healthcare Provider Details

I. General information

NPI: 1487804522
Provider Name (Legal Business Name): VICTOR A TACCONELLI, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 135
SANTA BARBARA CA
93111-2341
US

IV. Provider business mailing address

5333 HOLLISTER AVE STE 135
SANTA BARBARA CA
93111-2341
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: VICTOR ANDREW TACCONELLI
Title or Position: OWNER
Credential: MD
Phone: 805-967-9311