Basic Information
| Provider Information | |||||||||
| NPI: | 1770681116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOWBLANSKY | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4070 SONRIENTE RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931102445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056825354 | ||||||||
| FaxNumber: | 8056825351 | ||||||||
| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | G51029 | CA | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | ZZZA56032 | 01 | CA | BLUE SHIELD | OTHER | 050394 | 01 | CA | BLUE CROSS | OTHER | G51029 | 01 | CA | LICENSE NUMBER | OTHER | HSC30394F | 05 | CA | MEDICAID | ZZZ53994Z | 01 | CA | BLUE SHIELD | OTHER | ZZT40394F | 05 | CA | MEDICAID |