Healthcare Provider Details

I. General information

NPI: 1487490132
Provider Name (Legal Business Name): NERVIO PAIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ANACAPA ST APT A
SANTA BARBARA CA
93101-1653
US

IV. Provider business mailing address

612 ANACAPA ST APT A
SANTA BARBARA CA
93101-1653
US

V. Phone/Fax

Practice location:
  • Phone: 805-272-0020
  • Fax: 651-666-1610
Mailing address:
  • Phone: 805-272-0020
  • Fax: 651-666-1610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS EDWARD PETERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 651-707-4042