Provider Demographics
NPI:1275805681
Name:AULTMAN, MARVIN JOSEPH (LPT)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:JOSEPH
Last Name:AULTMAN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:AULTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPT
Mailing Address - Street 1:315 CAMINO DEL REMEDIO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1332
Mailing Address - Country:US
Mailing Address - Phone:805-681-5244
Mailing Address - Fax:805-681-4382
Practice Address - Street 1:315 CAMINO DEL REMEDIO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-681-5244
Practice Address - Fax:805-681-4382
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28820167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28820OtherBOARD OF VOCATIONAL NURSES AND PSYCHIATRIC TECHNICIANS