Provider Demographics
NPI:1134258320
Name:HOUSE CALLS MEDICAL GROUP
Entity type:Organization
Organization Name:HOUSE CALLS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYLSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-0414
Mailing Address - Street 1:2495 GLEN ALBYN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-682-0414
Mailing Address - Fax:805-524-0658
Practice Address - Street 1:2495 GLEN ALBYN DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-682-0414
Practice Address - Fax:805-524-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134258320OtherNPI NUMBER
1174652465OtherNPI NUMBER
CAG36944OtherLICENSE
WG36944AOtherMEDICARE PTAN
WI509OtherMEDICARE GROUP NUMBER
WG36944AOtherMEDICARE PTAN
1134258320OtherNPI NUMBER
WG36944AOtherMEDICARE PTAN