Healthcare Provider Details

I. General information

NPI: 1295156347
Provider Name (Legal Business Name): WILLIAM SANSUM DIABETES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 BATH ST
SANTA BARBARA CA
93105-4321
US

IV. Provider business mailing address

2219 BATH ST
SANTA BARBARA CA
93105-4321
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7638
  • Fax: 805-682-3332
Mailing address:
  • Phone: 805-682-7638
  • Fax: 805-682-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. ELLEN M. GOODSTEIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-682-7638