Healthcare Provider Details

I. General information

NPI: 1043586688
Provider Name (Legal Business Name): PACIFIC PLASTIC SURGEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 STATE ST SUITE 102
SANTA BARBARA CA
93101-2458
US

IV. Provider business mailing address

1722 STATE ST SUITE 102
SANTA BARBARA CA
93101-2458
US

V. Phone/Fax

Practice location:
  • Phone: 805-898-0700
  • Fax: 805-898-0600
Mailing address:
  • Phone: 805-898-0700
  • Fax: 805-898-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA15071
License Number StateCA

VIII. Authorized Official

Name: MS. JESSICA HOPE BARKER
Title or Position: PHYSICIAN ASSISTANT
Credential: P.A.
Phone: 805-898-0700