Provider Demographics
NPI:1386779270
Name:SANTA BARBARA ARTIFICIAL KIDNEY CENTER, LLC
Entity type:Organization
Organization Name:SANTA BARBARA ARTIFICIAL KIDNEY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-563-0090
Mailing Address - Street 1:1704 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2522
Mailing Address - Country:US
Mailing Address - Phone:805-563-0090
Mailing Address - Fax:805-569-2643
Practice Address - Street 1:1704 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2522
Practice Address - Country:US
Practice Address - Phone:805-563-0090
Practice Address - Fax:805-569-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08000659261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02606HMedicaid
CA052606Medicare ID - Type Unspecified