Provider Demographics
NPI:1790949832
Name:BACHRACH, MINDY B
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:B
Last Name:BACHRACH
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 1:2648 STATE ST APT 30
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3585
Mailing Address - Country:US
Mailing Address - Phone:805-204-8777
Mailing Address - Fax:
Practice Address - Street 1:2648 STATE ST APT 30
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3585
Practice Address - Country:US
Practice Address - Phone:805-204-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7782174400000X
NY007438-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist