Provider Demographics
NPI:1790109692
Name:GOLETA NEIGHBORHOOD CLINIC
Entity Type:Organization
Organization Name:GOLETA NEIGHBORHOOD CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREUNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH MBA
Authorized Official - Phone:805-617-7851
Mailing Address - Street 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7850
Mailing Address - Fax:805-963-8880
Practice Address - Street 1:334 S PATTERSON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93111-2400
Practice Address - Country:US
Practice Address - Phone:805-617-7878
Practice Address - Fax:805-617-7880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA BARBARA NEIGHBORHOOD CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-12
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002691261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002691OtherCLINIC LICENSE