=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689230450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS EDWARD PETERSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2019
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 CHAPALA ST STE 102
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101-3496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-272-0020
-----------------------------------------------------
Fax | 651-666-1610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 ANACAPA ST APT A
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-272-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | A185351
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------