Provider Demographics
NPI:1457402273
Name:THE MEDCENTER, INC.
Entity Type:Organization
Organization Name:THE MEDCENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-681-7410
Mailing Address - Street 1:271 N FAIRVIEW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-6284
Mailing Address - Country:US
Mailing Address - Phone:805-681-7411
Mailing Address - Fax:805-681-7410
Practice Address - Street 1:271 N FAIRVIEW AVE STE 101
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-6284
Practice Address - Country:US
Practice Address - Phone:805-681-7411
Practice Address - Fax:805-681-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14270Medicare PIN