MEDICARE: DARRELL T LIND PA-C, MS, MPH

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	363AM0700X	Medical Physician Assistant	PA17700	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1770583304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL T LIND PA-C, MS, MPH

Provider Business Mailing Address
First Line	:	109 W MISSION ST APT B
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2782
Country	:	US
Telephone Number	:	805-252-5610
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W MISSION ST APT B
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2782
Country	:	US
Telephone Number	:	805-252-5610
Fax Number	:

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	11/16/2021

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