Provider Demographics
NPI:1194870220
Name:VICTORIA, RAFAEL SOLLESA (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:SOLLESA
Last Name:VICTORIA
Suffix:
Gender:M
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: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:805-566-5080
Mailing Address - Fax:805-566-5007
Practice Address - Street 1:4806 CARPINTERIA AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1935
Practice Address - Country:US
Practice Address - Phone:805-566-5080
Practice Address - Fax:805-566-5007
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52387207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52387OtherPHYSICIAN'S LICENSE
CA00A523870Medicaid
CA00A523870Medicaid
CAWA52387BMedicare PIN
CAI25293Medicare UPIN