Provider Demographics
NPI:1588144257
Name:PAVLAKOVICH, ALIN
Entity type:Individual
Prefix:
First Name:ALIN
Middle Name:
Last Name:PAVLAKOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CAMINO DEL REMEDIO RM 257
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:805-681-4777
Mailing Address - Fax:805-681-5117
Practice Address - Street 1:315 CAMINO DEL REMEDIO RM 257
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:805-681-4777
Practice Address - Fax:805-681-5117
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA193400000XMedicaid