Healthcare Provider Details

I. General information

NPI: 1225355720
Provider Name (Legal Business Name): AMOL PATIL MD, MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST 113
SANTA BARBARA CA
93105-4339
US

IV. Provider business mailing address

2320 BATH ST 113
SANTA BARBARA CA
93105-4339
US

V. Phone/Fax

Practice location:
  • Phone: 805-560-8111
  • Fax:
Mailing address:
  • Phone: 805-560-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number133973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: