Basic Information
| Provider Information | |||||||||
| NPI: | 1104908292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOOKSPAN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50706 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931500706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059633757 | ||||||||
| FaxNumber: | 8055643332 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W PUEBLO ST RM 3635 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056823610 | ||||||||
| FaxNumber: | 8056823050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | G36429 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207R00000X | G36429 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.