Provider Demographics
NPI: | 1922279819 |
---|---|
Name: | LIFE NETWORK, INC |
Entity Type: | Organization |
Organization Name: | LIFE NETWORK, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SUSANNE |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | RAMOS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 805-967-9096 |
Mailing Address - Street 1: | 185 S PATTERSON AVE STE C |
Mailing Address - Street 2: | |
Mailing Address - City: | SANTA BARBARA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93111-2074 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-967-9096 |
Mailing Address - Fax: | 805-964-4479 |
Practice Address - Street 1: | 185 S PATTERSON AVE STE C |
Practice Address - Street 2: | |
Practice Address - City: | SANTA BARBARA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93111-2074 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-967-9096 |
Practice Address - Fax: | 805-964-4479 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-18 |
Last Update Date: | 2008-03-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |