Healthcare Provider Details

I. General information

NPI: 1215398953
Provider Name (Legal Business Name): CENTRAL COAST MOVEMENT DISORDERS SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E MICHELTORENA ST
SANTA BARBARA CA
93103-2257
US

IV. Provider business mailing address

515 E MICHELTORENA ST
SANTA BARBARA CA
93103-2257
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-3234
  • Fax:
Mailing address:
  • Phone: 805-563-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number20A12263
License Number StateCA

VIII. Authorized Official

Name: SARAH KEMPLE-MEHL
Title or Position: PRESIDENT
Credential: MD
Phone: 805-563-3234