Healthcare Provider Details

I. General information

NPI: 1073505715
Provider Name (Legal Business Name): SANTA BARBARA RADIOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

PO BOX 4219
ORANGE CA
92863-4219
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-7279
  • Fax: 805-569-8279
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS C. DAUGHTERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-569-7279