Provider Demographics
NPI:1528105038
Name:SANTA BARBARA CARDIOVASCULAR MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SANTA BARBARA CARDIOVASCULAR MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-682-7707
Mailing Address - Street 1:2400 BATH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4351
Mailing Address - Country:US
Mailing Address - Phone:805-682-7707
Mailing Address - Fax:805-682-7710
Practice Address - Street 1:2400 BATH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4351
Practice Address - Country:US
Practice Address - Phone:805-682-7707
Practice Address - Fax:805-682-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71348ZMedicaid
CAW1603Medicare ID - Type Unspecified