Basic Information
| Provider Information | |||||||||
| NPI: | 1598341711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOARES MEDICAL CORPORATION | ||||||||
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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 195 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059671359 | ||||||||
| FaxNumber: | 8056833319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2021 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | LOPEZ | ||||||||
| AuthorizedOfficialFirstName: | KRISTYN | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8059671359 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.