Provider Demographics
NPI:1689396103
Name:HEWITT, MICHAELA RAINE
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:RAINE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3362
Mailing Address - Country:US
Mailing Address - Phone:734-680-3651
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH SERVICE
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, SANTA BARBARA
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106
Practice Address - Country:US
Practice Address - Phone:805-893-5361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95255385163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10591527OtherUCSB