Provider Demographics
NPI:1265458434
Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Entity Type:Organization
Organization Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Other - Org Name:ISLA VISTA 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 1:970 EMBARCADERO DEL MAR
Practice Address - Street 2:
Practice Address - City:ISLA VISTA
Practice Address - State:CA
Practice Address - Zip Code:93117-4869
Practice Address - Country:US
Practice Address - Phone:805-968-1511
Practice Address - Fax:805-968-7041
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:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000089261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70097GMedicaid
CACLN 1073OtherBOARD OF PHARMACY CLINIC PERMIT
CAHAP70097GOtherFAMILYPACT PROVIDER NUMBE
CA05D0584453OtherCLIA
CABCP70097GMedicaid
CACLP 303897OtherDHS LAB REGISTRATION NUMBER
CA05-0000089OtherCOMMUNITY CLINIC LICENSE
CA167273OtherCCS
CA167273OtherCCS