Healthcare Provider Details

I. General information

NPI: 1851634745
Provider Name (Legal Business Name): THAIDRA A GAUFIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W PUEBLO ST
SANTA BARBARA CA
93105-4365
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-7500
  • Fax:
Mailing address:
  • Phone: 805-681-1760
  • Fax: 805-681-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA134177
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA134177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: