Provider Demographics
NPI:1356981096
Name:MONTECITO GERIATRIC MEDICAL GROUP INC
Entity type:Organization
Organization Name:MONTECITO GERIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:FEARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-963-1997
Mailing Address - Street 1:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-1997
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:219 NOGALES AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3848
Practice Address - Country:US
Practice Address - Phone:805-969-4382
Practice Address - Fax:805-284-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty