=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770770778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. REGINA VERNICE PIPERSBURG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 10/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 N SAN ANTONIO RD
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93110-1399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-884-1629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2619 LONG TER
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93455-7439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-739-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | A6536119
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------