Provider Demographics
NPI:1003226762
Name:ALLEN J THOMASHEFSKY, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALLEN J THOMASHEFSKY, MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMASHEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-962-2662
Mailing Address - Street 1:2320 BATH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4345
Mailing Address - Country:US
Mailing Address - Phone:805-962-2662
Mailing Address - Fax:805-569-5670
Practice Address - Street 1:2320 BATH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4345
Practice Address - Country:US
Practice Address - Phone:805-962-2662
Practice Address - Fax:805-569-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22085261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90744Medicare UPIN