Provider Demographics
NPI:1558858035
Name:HULLANDER AND MOZINGO LP
Entity Type:Organization
Organization Name:HULLANDER AND MOZINGO LP
Other - Org Name:PACIFIC PAIN PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-563-0363
Mailing Address - Street 1:222 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3805
Mailing Address - Country:US
Mailing Address - Phone:805-563-0363
Mailing Address - Fax:805-563-0364
Practice Address - Street 1:1551 BISHOP ST STE 220
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4661
Practice Address - Country:US
Practice Address - Phone:805-563-0363
Practice Address - Fax:805-563-0364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HULLANDER AND MOZINGO LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68228208VP0014X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty