Healthcare Provider Details

I. General information

NPI: 1538191689
Provider Name (Legal Business Name): NANCY GAY NUDELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY NUDELL KUPPERMAN M.D.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4085 CUERVO AVE
SANTA BARBARA CA
93110-2411
US

IV. Provider business mailing address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-2199
  • Fax:
Mailing address:
  • Phone: 805-681-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA034292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: