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General NPI Number Information
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NPI Number | 1740394170
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Entity Type | Individual
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Provider Name | JEROLD A BLACK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 51 HITCHCOCK WAY
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City | SANTA BARBARA
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State | CA
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Zip | 93105-3101
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Country | US
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Telephone | 805-563-6211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62106
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City | SANTA BARBARA
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State | CA
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Zip | 93160-2106
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Country | US
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Telephone | 805-681-1761
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Fax | 805-681-1768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A76157
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License Number State | CA
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