Provider Demographics
NPI:1154404432
Name:BIRSKOVICH, LORRAINE M (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:BIRSKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-3262
Mailing Address - Country:US
Mailing Address - Phone:805-681-7411
Mailing Address - Fax:805-681-7410
Practice Address - Street 1:271 N FAIRVIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-6284
Practice Address - Country:US
Practice Address - Phone:805-681-7411
Practice Address - Fax:805-965-3441
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG87401OtherLICENSE CA
CAWG87401AMedicare PIN
CAW14270Medicare PIN
CAW14270AMedicare PIN