Healthcare Provider Details

I. General information

NPI: 1518398718
Provider Name (Legal Business Name): PEGGY TRAVIS CMF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 STATE ST
SANTA BARBARA CA
93105-3304
US

IV. Provider business mailing address

2345 S BROADWAY STE E
SANTA MARIA CA
93454-7840
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-8290
  • Fax: 805-346-8713
Mailing address:
  • Phone: 805-925-8290
  • Fax: 805-346-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberCFM00860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: