1417961087 NPI number — MICHAEL SIPIORA PH.D.

Table of content: MICHAEL SIPIORA PH.D. (NPI 1417961087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417961087 NPI number — MICHAEL SIPIORA PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIPIORA
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417961087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1475 NAMOUNA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARPINTERIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93013-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-729-7369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 W MICHELTORENA ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-6522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-729-7369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS008354L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PSY 23191 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1418914 . This is a "BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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