Basic Information
| Provider Information | |||||||||
| NPI: | 1598728735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAMINSKI | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | PUEBLO AT BATH | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931020689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055697451 | ||||||||
| FaxNumber: | 8055697890 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 W PUEBLO ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931054311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055697451 | ||||||||
| FaxNumber: | 8055697890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 12/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G82149 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | G82149 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 00G821490 | 05 | CA | MEDICAID |