Provider Demographics
NPI:1992779417
Name:SANTA YNEZ BAND OF MISSION INDIANS
Entity type:Organization
Organization Name:SANTA YNEZ BAND OF MISSION INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINACIAL SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-688-7070
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-0539
Mailing Address - Country:US
Mailing Address - Phone:805-688-7070
Mailing Address - Fax:805-686-2060
Practice Address - Street 1:90 VIA JUANA LANE
Practice Address - Street 2:
Practice Address - City:SANTA YNEZ
Practice Address - State:CA
Practice Address - Zip Code:93460-9405
Practice Address - Country:US
Practice Address - Phone:805-688-7070
Practice Address - Fax:805-686-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70024FMedicaid
CAZZZ-540482OtherBLUE SHIELD GROUP NUMBER
CAZZZ-540482OtherBLUE SHIELD GROUP NUMBER