Provider Demographics
NPI:1285931436
Name:AGELESS MEN'S HEALTH CA, PC
Entity type:Organization
Organization Name:AGELESS MEN'S HEALTH CA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-818-0446
Mailing Address - Street 1:3905 STATE STREET
Mailing Address - Street 2:#3
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5101
Mailing Address - Country:US
Mailing Address - Phone:805-687-8378
Mailing Address - Fax:805-687-8377
Practice Address - Street 1:3905 STATE STREET
Practice Address - Street 2:#3
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5101
Practice Address - Country:US
Practice Address - Phone:805-687-8378
Practice Address - Fax:805-687-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty