Healthcare Provider Details

I. General information

NPI: 1588064182
Provider Name (Legal Business Name): SANTA BARBARA PLASTIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W PUEBLO ST STE A
SANTA BARBARA CA
93105-6206
US

IV. Provider business mailing address

427 W PUEBLO ST STE A
SANTA BARBARA CA
93105-6206
US

V. Phone/Fax

Practice location:
  • Phone: 805-687-7336
  • Fax: 805-687-9491
Mailing address:
  • Phone: 805-687-7336
  • Fax: 805-687-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC39437
License Number StateCA

VIII. Authorized Official

Name: MRS. ROCHELLE GREEN
Title or Position: BILLING MANAGER
Credential:
Phone: 805-402-7323