Healthcare Provider Details

I. General information

NPI: 1073801866
Provider Name (Legal Business Name): SANTA BARBARA EXTREMITY MRI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 DE LA VINA ST SUITE 205
SANTA BARBARA CA
93105-3354
US

IV. Provider business mailing address

2927 DE LA VINA ST SUITE A
SANTA BARBARA CA
93105-3362
US

V. Phone/Fax

Practice location:
  • Phone: 805-679-7593
  • Fax: 805-879-9052
Mailing address:
  • Phone: 805-679-7593
  • Fax: 805-879-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENNAN P DE RAAD
Title or Position: DIRECTOR
Credential:
Phone: 805-679-7593