Provider Demographics
NPI:1376973974
Name:SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:SANTA BARBARA SAN LUIS OBISPO REGIONAL HEALTH AUTHORITY
Other - Org Name:CENCAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-562-1641
Mailing Address - Street 1:4050 CALLE REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-3413
Mailing Address - Country:US
Mailing Address - Phone:805-685-9525
Mailing Address - Fax:805-964-0540
Practice Address - Street 1:4050 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-3413
Practice Address - Country:US
Practice Address - Phone:805-685-9525
Practice Address - Fax:805-964-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953869541302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSS00046FOtherMSSP PROVIDER NUMBER