Provider Demographics
NPI:1225054414
Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Entity Type:Organization
Organization Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Other - Org Name:WESTSIDE NEIGHBORHOOD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CAMILLO
Authorized Official - Last Name:FENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-617-7850
Mailing Address - Street 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7858
Mailing Address - Fax:805-963-8880
Practice Address - Street 1:628 W MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4131
Practice Address - Country:US
Practice Address - Phone:805-963-1546
Practice Address - Fax:805-962-4771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA BARBARA NEIGHBORHOOD CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2016-03-03
Deactivation Date:2006-12-01
Deactivation Code:
Reactivation Date:2007-02-08
Provider Licenses
StateLicense IDTaxonomies
CA050000091261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598942492OtherCPD NPI
CAFHC12002GMedicaid
CA168902OtherCCS
CABCP12002GOtherCDP
FHC12002GOtherCHDP
CA1407033301OtherFAMPACT NPI
CACLN 1074OtherBOARD OF PHARMACY CLINIC PERMIT
CAHAP12002GOtherFP
CA05D0584453OtherCLIA
CACLP 303897OtherDHS LAB REGISTRATION NUMBER
CACLN 1074OtherBOARD OF PHARMACY CLINIC PERMIT