Basic Information
| Provider Information | |||||||||
| NPI: | 1902840176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEWITT | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3916 STATE ST | ||||||||
| Address2: | #300 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931055602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633011 | ||||||||
| FaxNumber: | 8055645087 | ||||||||
| Practice Location | |||||||||
| Address1: | 15630 18TH AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARLAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954229336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079955890 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/14/2009 | ||||||||
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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 | 207P00000X | A31314 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1902840716BG017Z | 01 | CA | UPI# | OTHER | 1902840176 | 05 | CA | MEDICAID |