Basic Information
| Provider Information | |||||||||
| NPI: | 1558858035 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HULLANDER AND MOZINGO LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PACIFIC PAIN PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 W PUEBLO ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931053805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055630363 | ||||||||
| FaxNumber: | 8055630364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 BISHOP ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055630363 | ||||||||
| FaxNumber: | 8055630364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2018 | ||||||||
| LastUpdateDate: | 04/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOLMLUND | ||||||||
| AuthorizedOfficialFirstName: | JUSTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8055630363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HULLANDER AND MOZINGO LP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | CA | N | Suppliers | Durable Medical Equipment & Medical Supplies | 208VP0014X | G68228 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.