Healthcare Provider Details

I. General information

NPI: 1528157138
Provider Name (Legal Business Name): HEATHER RAE MERRICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER HAVENS

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BATH ST STE 102
SANTA BARBARA CA
93105-4351
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-324-9144
  • Fax: 805-749-2918
Mailing address:
  • Phone: 805-324-9144
  • Fax: 805-749-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: