Provider Demographics
NPI:1720165525
Name:SWEENEY, MARA K (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:K
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2513
Mailing Address - Country:US
Mailing Address - Phone:805-560-6675
Mailing Address - Fax:805-618-1534
Practice Address - Street 1:1509 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2513
Practice Address - Country:US
Practice Address - Phone:805-560-6675
Practice Address - Fax:805-618-1534
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84763174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI38583Medicare UPIN