Provider Demographics
NPI:1245257963
Name:MOZINGO, RALPH D (DO)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:D
Last Name:MOZINGO
Suffix:
Gender:M
Credentials:DO
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 3880
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-3880
Mailing Address - Country:US
Mailing Address - Phone:805-563-0363
Mailing Address - Fax:805-563-0364
Practice Address - Street 1:3045 DE LA VINA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3351
Practice Address - Country:US
Practice Address - Phone:805-563-0363
Practice Address - Fax:805-563-0364
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6316207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF76711Medicare UPIN
CAW20A6316CMedicare ID - Type Unspecified