MEDICARE: MRS. MARISSA PIACENTI JOBE PA-C

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	363A00000X	Physician Assistant	23011812	NY
2	363A00000X	Physician Assistant	53220	CA

General Provider Information

NPI Number	:	1740302413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARISSA PIACENTI JOBE PA-C

Provider Business Mailing Address
First Line	:	1612 SHORELINE DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-2024
Country	:	US
Telephone Number	:	347-405-4211
Fax Number	:	805-569-8206

Provider Business Practice Location Address
First Line	:	540 W PUEBLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4230
Country	:	US
Telephone Number	:	805-879-0670
Fax Number	:	805-569-8206

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/10/2019

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