Provider Demographics
NPI:1538282587
Name:ENGSTROM, TODD WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:ENGSTROM
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:PO BOX 62106
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-2106
Mailing Address - Country:US
Mailing Address - Phone:805-681-7761
Mailing Address - Fax:805-681-1768
Practice Address - Street 1:4806 CARPINTERIA AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1935
Practice Address - Country:US
Practice Address - Phone:805-566-5080
Practice Address - Fax:805-566-5007
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG89358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538282587Medicaid
CA051847Medicare Oscar/Certification
CA151872Medicare Oscar/Certification
CAW1508Medicare PIN
CA551907Medicare Oscar/Certification
CA551983Medicare Oscar/Certification
CAW1508AMedicare PIN
CAW1508EMedicare PIN
CA1538282587Medicaid
CAW1508GMedicare PIN