Provider Demographics
NPI:1902822356
Name:CAVINS, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:CAVINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 HOLLISTER AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3825
Mailing Address - Country:US
Mailing Address - Phone:805-687-7719
Mailing Address - Fax:805-682-2971
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-687-7719
Practice Address - Fax:805-682-2971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A249730Medicaid
CA4551410001Medicare NSC
CAA24973Medicare PIN
CA00A249730Medicaid