Provider Demographics
NPI:1013480128
Name:SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA BARBARA INC.
Entity Type:Organization
Organization Name:SPINE AND PAIN TREATMENT MEDICAL CENTER OF SANTA BARBARA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-264-3388
Mailing Address - Street 1:218 N I ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-0909
Mailing Address - Country:US
Mailing Address - Phone:805-264-3388
Mailing Address - Fax:
Practice Address - Street 1:1130 COFFEE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4228
Practice Address - Country:US
Practice Address - Phone:805-264-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical