Healthcare Provider Details

I. General information

NPI: 1417175423
Provider Name (Legal Business Name): PEDIATRIC SUBSPECIALTY NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 CASTILLO ST SUITE 202
SANTA BARBARA CA
93105-5316
US

IV. Provider business mailing address

2403 CASTILLO ST SUITE 202
SANTA BARBARA CA
93105-5316
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-2775
  • Fax:
Mailing address:
  • Phone: 805-682-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMIR KESHEN
Title or Position: OWNER
Credential: MD
Phone: 805-682-2775