Provider Demographics
NPI:1235565565
Name:NEUROLOGICAL SURGERY OF SANTA
Entity Type:Organization
Organization Name:NEUROLOGICAL SURGERY OF SANTA
Other - Org Name:NEUROLOGICAL SURGERY OF SANTA BARBARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-1912
Mailing Address - Street 1:2410 FLETCHER AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4828
Mailing Address - Country:US
Mailing Address - Phone:805-682-1912
Mailing Address - Fax:805-682-1844
Practice Address - Street 1:2410 FLETCHER AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4828
Practice Address - Country:US
Practice Address - Phone:805-682-1912
Practice Address - Fax:805-682-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty