Basic Information
| Provider Information | |||||||||
| NPI: | 1295897908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7761 JENNA DR | ||||||||
| Address2: | |||||||||
| City: | GOLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931171072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055621761 | ||||||||
| FaxNumber: | 8057331213 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W PUEBLO ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931054353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2006 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | A24588 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 174400000X | A24588 | CA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | A24588 | 01 | CA | MEDICARE | OTHER | 00A245880 | 05 | CA | MEDICAID |