Basic Information
| Provider Information | |||||||||
| NPI: | 1881934594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUEBLO SANTA BARBARA WOMEN'S IMAGING ASSOCIATES, INC | ||||||||
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| OtherOrganizationName: | SANTA BARBARA WOMEN'S IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1326 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931021326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056827984 | ||||||||
| FaxNumber: | 8055692964 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 STATE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055608111 | ||||||||
| FaxNumber: | 8055606900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2013 | ||||||||
| LastUpdateDate: | 02/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEUNG | ||||||||
| AuthorizedOfficialFirstName: | WINIFRED | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056827984 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PUEBLO RADIOLOGY MEDICAL GROUP, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.