Basic Information
| Provider Information | |||||||||
| NPI: | 1275607160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOARES | ||||||||
| FirstName: | JULIO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5333 HOLLISTER AVE STE 195 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059671359 | ||||||||
| FaxNumber: | 8056833319 | ||||||||
| Practice Location | |||||||||
| Address1: | 5333 HOLLISTER AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931113309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059671359 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A32832 | CA | N | Other Service Providers | Specialist | 208200000X | A32832 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 770143765 | 01 | CA | TAX ID | OTHER | A32832 | 01 | CA | CALIFORNIA LICENSE | OTHER |