Basic Information
| Provider Information | |||||||||
| NPI: | 1528048931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSTETTER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CLYDE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3916 STATE ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931053137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313854603 | ||||||||
| FaxNumber: | 8313850414 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | KING CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939303431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313856000 | ||||||||
| FaxNumber: | 8313850414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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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 | 207P00000X | G33650 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | G33650 | CA | N | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 00G336500 | 05 | CA | MEDICAID |