Provider Demographics
NPI:1518398718
Name:TRAVIS, PEGGY (CMF)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 S BROADWAY STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7840
Mailing Address - Country:US
Mailing Address - Phone:805-925-8290
Mailing Address - Fax:805-346-8713
Practice Address - Street 1:3010 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3304
Practice Address - Country:US
Practice Address - Phone:805-925-8290
Practice Address - Fax:805-346-8713
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFM00860224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter