Basic Information
Provider Information | |||||||||
NPI: | 1629176284 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROWNE | ||||||||
FirstName: | RICHARD | ||||||||
MiddleName: | BLACKMAR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 420 CANON DR | ||||||||
Address2: |   | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 931052643 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056824797 | ||||||||
FaxNumber: | 8056823415 | ||||||||
Practice Location | |||||||||
Address1: | 147 N BRENT ST | ||||||||
Address2: |   | ||||||||
City: | VENTURA | ||||||||
State: | CA | ||||||||
PostalCode: | 930032809 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056525011 | ||||||||
FaxNumber: | 8055853007 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/20/2006 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | G25064 | CA | Y |   | Emergency Medical Service Providers | Personal Emergency Response Attendant |   |
ID Information
ID | Type | State | Issuer | Description | ZZZ53994Z | 01 | CA | BLUE SHIELD | OTHER | ZZZA56032 | 01 | CA | BLUE SHIELD | OTHER | G25064 | 01 | CA | CALIFORNIA LICENSE NUMBER | OTHER | 050394 | 01 | CA | BLUE CROSS | OTHER | HSC30394F | 05 | CA |   | MEDICAID | ZZT40394F | 05 | CA |   | MEDICAID |