Provider Demographics
NPI:1124124276
Name:MATHISON, KARI (MD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:MATHISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAROLEE
Other - Middle Name:
Other - Last Name:MATHISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 62106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-2106
Mailing Address - Country:US
Mailing Address - Phone:805-563-6120
Mailing Address - Fax:
Practice Address - Street 1:1919 STATE ST STE 307
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-563-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G849190Medicaid
CAG36189Medicare UPIN
CAWG84919AMedicare PIN