MEDICARE: MARA K SWEENEY M.D.

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	174400000X	Specialist	A84763	CA
2	207R00000X	Internal Medicine Physician	A84763	CA

General Provider Information

NPI Number	:	1720165525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA K SWEENEY M.D.

Provider Business Mailing Address
First Line	:	1509 STATE ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2513
Country	:	US
Telephone Number	:	805-560-6675
Fax Number	:	805-618-1534

Provider Business Practice Location Address
First Line	:	1509 STATE ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2513
Country	:	US
Telephone Number	:	805-560-6675
Fax Number	:	805-618-1534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	09/28/2020

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