Provider Demographics
NPI:1063438232
Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Entity type:Organization
Organization Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CAMILLO
Authorized Official - Last Name:FENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-617-7850
Mailing Address - Street 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7858
Mailing Address - Fax:805-898-2002
Practice Address - Street 1:915 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2331
Practice Address - Country:US
Practice Address - Phone:805-963-1641
Practice Address - Fax:805-962-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000113261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050000113OtherCOMMUNITY CLINIC LICENSE
CAHAP70114GOtherFAMPACT LEGACY NUMBER
CABCP70114GOtherCDP PROVIDER NUMBER
CAEAP70114GOtherEAPC PROVIDER NUMBER
CACLP 303897OtherDHS LAB REGISTRATION NUMBER
CA168904OtherCCS
CA05D0584453OtherCLIA NUMBER
CACLN 1072OtherBOARD OF PHARMACY CLINIC PERMIT
CAFHC70114GMedicaid
CAW15965Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER