Healthcare Provider Details

I. General information

NPI: 1598341711
Provider Name (Legal Business Name): SOARES MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 HOLLISTER AVE STE 195
SANTA BARBARA CA
93111-2465
US

IV. Provider business mailing address

5333 HOLLISTER AVE STE 195
SANTA BARBARA CA
93111-2465
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 Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTYN ANN LOPEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-967-1359