Provider Demographics
NPI:1982652780
Name:LAUB, DAVID JONATHAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JONATHAN
Last Name:LAUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30701
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0701
Mailing Address - Country:US
Mailing Address - Phone:805-698-4080
Mailing Address - Fax:805-569-2542
Practice Address - Street 1:5333 HOLLISTER AVE STE 275
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2472
Practice Address - Country:US
Practice Address - Phone:805-569-2462
Practice Address - Fax:805-569-2542
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62203208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G622030Medicaid
CA00G622030Medicaid
CAF11653Medicare UPIN