Basic Information
Provider Information | |||||||||
NPI: | 1609932276 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SANTA BARBARA COUNTY AUDITOR | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PHYSICIANS' MEDICAL GROUP | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 300 N SAN ANTONIO RD | ||||||||
Address2: |   | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 931101316 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056815461 | ||||||||
FaxNumber: | 8056815200 | ||||||||
Practice Location | |||||||||
Address1: | 301 N R ST | ||||||||
Address2: |   | ||||||||
City: | LOMPOC | ||||||||
State: | CA | ||||||||
PostalCode: | 934365226 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8057376400 | ||||||||
FaxNumber: | 8057376430 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/28/2006 | ||||||||
LastUpdateDate: | 07/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GAMBLE | ||||||||
AuthorizedOfficialFirstName: | DANA | ||||||||
AuthorizedOfficialMiddleName: | BRUCE | ||||||||
AuthorizedOfficialTitleorPosition: | DEPUTY DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8056815171 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SANTA BARBARA COUNTY AUDITOR | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LCSW | ||||||||
NPICertificationDate: | 07/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center |   | 261QF0400X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QM1300X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QP2300X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QR0200X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QU0200X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QF0050X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
ID Information
ID | Type | State | Issuer | Description | HAP16134F | 01 | CA | LOMPOC CLINIC HAP NUMBER | OTHER |