Provider Demographics
NPI:1598341711
Name:SOARES MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SOARES MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-967-1359
Mailing Address - Street 1:5333 HOLLISTER AVE STE 195
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2465
Mailing Address - Country:US
Mailing Address - Phone:805-967-1359
Mailing Address - Fax:805-683-3319
Practice Address - Street 1:5333 HOLLISTER AVE STE 195
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2465
Practice Address - Country:US
Practice Address - Phone:805-967-1359
Practice Address - Fax:805-683-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty