Healthcare Provider Details

I. General information

NPI: 1225233760
Provider Name (Legal Business Name): KATRINA BLACKBURN MITCHELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W PUEBLO ST
SANTA BARBARA CA
93105
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-0670
  • Fax:
Mailing address:
  • Phone: 805-681-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC161065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: