Healthcare Provider Details

I. General information

NPI: 1285144246
Provider Name (Legal Business Name): JUSTES RYLAN ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

IV. Provider business mailing address

107 E MICHELTORENA ST
SANTA BARBARA CA
93101-1905
US

V. Phone/Fax

Practice location:
  • Phone: 805-965-3434
  • Fax: 805-965-3797
Mailing address:
  • Phone: 805-965-3434
  • Fax: 805-965-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: