Provider Demographics
NPI:1952561698
Name:TRIPLETT, MICHAEL (BA RDCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TRIPLETT
Suffix:
Gender:M
Credentials:BA RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WINCHESTER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1005
Mailing Address - Country:US
Mailing Address - Phone:805-680-3784
Mailing Address - Fax:805-685-3715
Practice Address - Street 1:401 WINCHESTER CANYON RD
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1005
Practice Address - Country:US
Practice Address - Phone:805-680-3784
Practice Address - Fax:805-685-3715
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDCS 24327246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG061Medicare PIN