Provider Demographics
NPI:1497033278
Name:ROBERTA D SENGELMANN MD INC
Entity Type:Organization
Organization Name:ROBERTA D SENGELMANN MD INC
Other - Org Name:SANTA BARBARA SKIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SENGELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-963-3757
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:2921 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3309
Practice Address - Country:US
Practice Address - Phone:805-770-3999
Practice Address - Fax:805-770-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG88181207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG88181OtherSTATE LICENSE
CAG88181OtherSTATE LICENSE