=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396138103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARIDA BOUNOUA MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2015
-----------------------------------------------------
Last Update Date | 03/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 DE LA VINA ST SUITE 207
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93105-3877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-879-4011
-----------------------------------------------------
Fax | 805-879-4021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1206
-----------------------------------------------------
City | GOLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93116-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-964-3838
-----------------------------------------------------
Fax | 805-683-3400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FARIDA BOUNOUA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-879-4011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | A89619
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------