Healthcare Provider Details

I. General information

NPI: 1407877632
Provider Name (Legal Business Name): BOTROUS KAMEL TAWADROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CENTERPOINTE PKWY
SANTA MARIA CA
93455-1334
US

IV. Provider business mailing address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-346-7230
  • Fax: 805-346-7272
Mailing address:
  • Phone: 805-681-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA50729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: