Healthcare Provider Details

I. General information

NPI: 1992779417
Provider Name (Legal Business Name): SANTA YNEZ BAND OF MISSION INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VIA JUANA LANE
SANTA YNEZ CA
93460-9405
US

IV. Provider business mailing address

PO BOX 539
SANTA YNEZ CA
93460-0539
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-7070
  • Fax: 805-686-2060
Mailing address:
  • Phone: 805-688-7070
  • Fax: 805-686-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER JASSO
Title or Position: FINACIAL SERVICES MANAGER
Credential:
Phone: 805-688-7070