Healthcare Provider Details

I. General information

NPI: 1144648015
Provider Name (Legal Business Name): SANSUM CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 FOOTHILL RD
SANTA BARBARA CA
93110-1110
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-7761
  • Fax: 805-681-1768
Mailing address:
  • Phone: 805-681-7761
  • Fax: 805-681-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAD HINE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 805-681-7709