Provider Demographics
NPI:1699742882
Name:NEUROSURGICAL ASSC SANTA BARBARA
Entity type:Organization
Organization Name:NEUROSURGICAL ASSC SANTA BARBARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-682-2342
Mailing Address - Street 1:2410 FLETCHER AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4828
Mailing Address - Country:US
Mailing Address - Phone:805-682-1912
Mailing Address - Fax:805-682-1844
Practice Address - Street 1:2410 FLETCHER AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4828
Practice Address - Country:US
Practice Address - Phone:805-682-2342
Practice Address - Fax:805-682-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11578Medicare PIN