MEDICARE: AGELESS MEN'S HEALTH CA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1285931436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGELESS MEN'S HEALTH CA, PC

Provider Business Mailing Address
First Line	:	3905 STATE STREET
Second Line	:	#3
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-5101
Country	:	US
Telephone Number	:	805-687-8378
Fax Number	:	805-687-8377

Provider Business Practice Location Address
First Line	:	3905 STATE STREET
Second Line	:	#3
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-5101
Country	:	US
Telephone Number	:	805-687-8378
Fax Number	:	805-687-8378

Authorized Official
Title or Position	:	BUSINESS OPERATIONS DIRECTOR
Name	:	AMANDA WILKINSON
Credential	:
Telephone Number	:	702-818-0446

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	11/11/2024

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