Provider Demographics
NPI:1356650741
Name:BRIAN SANTINI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BRIAN SANTINI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-258-6137
Mailing Address - Street 1:8160 QUARTZ ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-4038
Mailing Address - Country:US
Mailing Address - Phone:805-265-6099
Mailing Address - Fax:
Practice Address - Street 1:3901 LAS POSAS RD STE 205
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1506
Practice Address - Country:US
Practice Address - Phone:805-258-6137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69228Medicare UPIN