Basic Information
| Provider Information | |||||||||
| NPI: | 1902182017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KSYNKINA | ||||||||
| FirstName: | IRINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60545 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931600545 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5385 HOLLISTER AVE BLDG 14 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056815450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2011 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 110883 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.