Provider Demographics
NPI:1740222934
Name:AMERICAN INDIAN HEALTH & SERVICES CORPORATION
Entity Type:Organization
Organization Name:AMERICAN INDIAN HEALTH & SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DEONNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-603-4059
Mailing Address - Street 1:3227 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3328
Mailing Address - Country:US
Mailing Address - Phone:805-681-7356
Mailing Address - Fax:805-681-7358
Practice Address - Street 1:4141 STATE ST STE B11
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1898
Practice Address - Country:US
Practice Address - Phone:805-681-7356
Practice Address - Fax:805-681-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50000515261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70786FOtherEAPC PROGRAM
CAFHC70786FMedicaid
CABCP70786FOtherCANCER DETECTION PROGRAM
CAEAP70786FOtherEAPC PROGRAM
CAW1456Medicare ID - Type Unspecified
551861Medicare PIN