Healthcare Provider Details

I. General information

NPI: 1619412780
Provider Name (Legal Business Name): BETH ANNE TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

5662 CALLE REAL 248
GOLETA CA
93117-2317
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-2775
  • Fax:
Mailing address:
  • Phone: 805-682-2775
  • Fax: 805-563-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95005167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: