Provider Demographics
NPI:1770770778
Name:PIPERSBURG, REGINA VERNICE
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:VERNICE
Last Name:PIPERSBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 LONG TER
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-7439
Mailing Address - Country:US
Mailing Address - Phone:805-739-8500
Mailing Address - Fax:
Practice Address - Street 1:429 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1399
Practice Address - Country:US
Practice Address - Phone:805-884-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA6536119261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health