MEDICARE: SWEENEY MEDICAL CORPORATION

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	W19538	CA

General Provider Information

NPI Number	:	1962526731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEENEY MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1805 E CABRILLO BLVD
Second Line	:	STE-C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2884
Country	:	US
Telephone Number	:	805-969-4025
Fax Number	:	805-565-8926

Provider Business Practice Location Address
First Line	:	1805 E CABRILLO BLVD
Second Line	:	STE C
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2884
Country	:	US
Telephone Number	:	805-969-4025
Fax Number	:	805-565-8926

Authorized Official
Title or Position	:	CEO
Name	:	MARA K SWEENEY
Credential	:	M.D.
Telephone Number	:	805-969-4025

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	10/19/2010

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