Healthcare Provider Details

I. General information

NPI: 1902435431
Provider Name (Legal Business Name): NATALIE GRAY KORNBLUTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

PO BOX 689
SANTA BARBARA CA
93102-0689
US

V. Phone/Fax

Practice location:
  • Phone: 805-569-8393
  • Fax: 805-450-2397
Mailing address:
  • Phone: 805-569-8393
  • Fax: 805-450-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: