Provider Demographics
NPI:1417995754
Name:SANTINI, BRIAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:SANTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:422 ARNEILL RD
Practice Address - Street 2:STE B
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6439
Practice Address - Country:US
Practice Address - Phone:805-383-4510
Practice Address - Fax:805-383-4511
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40394FMedicaid
CA050394OtherBLUE CROSS
CARHM08608FMedicaid
CARHM08609FMedicaid
CA95-1683892OtherOTHER INSURANCE
CARHM18553HMedicaid
CAWA83094CMedicare ID - Type UnspecifiedPPIN
CAWA83094EMedicare ID - Type UnspecifiedPPIN
CA95-1683892OtherOTHER INSURANCE
CA050394OtherBLUE CROSS
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CARHM08609FMedicaid
CARHM08608FMedicaid
CAWA83094AMedicare ID - Type UnspecifiedPPIN
CAWA83094DMedicare ID - Type UnspecifiedPPIN