Healthcare Provider Details

I. General information

NPI: 1669061594
Provider Name (Legal Business Name): PROSTATE INSTITUTE OF AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 300
SANTA BARBARA CA
93105-4382
US

IV. Provider business mailing address

2320 BATH ST STE 208
SANTA BARBARA CA
93105-5322
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-3082
  • Fax:
Mailing address:
  • Phone: 805-682-7744
  • Fax: 805-569-2964

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: M DEAN BLACK
Title or Position: PRESIDENT
Credential: MD
Phone: 805-682-7744