Healthcare Provider Details

I. General information

NPI: 1982065744
Provider Name (Legal Business Name): SWL MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 VILLAGE LN STE 101
SOLVANG CA
93463-2283
US

IV. Provider business mailing address

2027 VILLAGE LN STE 101
SOLVANG CA
93463-2283
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-1203
  • Fax:
Mailing address:
  • Phone: 805-688-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN LUTZKER
Title or Position: OWNER
Credential: MD
Phone: 805-688-1203