Healthcare Provider Details

I. General information

NPI: 1740302413
Provider Name (Legal Business Name): MARISSA PIACENTI JOBE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W PUEBLO ST
SANTA BARBARA CA
93105-4230
US

IV. Provider business mailing address

1612 SHORELINE DR
SANTA BARBARA CA
93109-2024
US

V. Phone/Fax

Practice location:
  • Phone: 805-879-0670
  • Fax: 805-569-8206
Mailing address:
  • Phone: 347-405-4211
  • Fax: 805-569-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number23011812
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: