Healthcare Provider Details

I. General information

NPI: 1346416427
Provider Name (Legal Business Name): MARC A SOARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 195
SANTA BARBARA CA
93111-2341
US

IV. Provider business mailing address

5333 HOLLISTER AVE STE 195
SANTA BARBARA CA
93111-2341
US

V. Phone/Fax

Practice location:
  • Phone: 805-967-1359
  • Fax: 805-683-3319
Mailing address:
  • Phone: 805-967-1359
  • Fax: 805-683-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA142572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: