Provider Demographics
NPI:1003577644
Name:CENTRAL CALIFORNIA MOVEMENT DISORDERS
Entity type:Organization
Organization Name:CENTRAL CALIFORNIA MOVEMENT DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-295-5226
Mailing Address - Street 1:418 CHAPALA ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-8055
Mailing Address - Country:US
Mailing Address - Phone:805-295-5226
Mailing Address - Fax:
Practice Address - Street 1:418 CHAPALA ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-8055
Practice Address - Country:US
Practice Address - Phone:805-295-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty