Organization
SANTA BARBARA NEIGHBORHOOD CLINICS
Active
Organization
SANTA BARBARA NEIGHBORHOOD CLINICS
Active
Other names
Eastside Neighborhood Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES CAMILLO FENZI M.D. (CHIEF EXECUTIVE OFFICER)
(805) 617-7850
Entity
Organization
Contact information
Practice address
915 N MILPAS ST, SANTA BARBARA, CA 93103-2331
(805) 963-1641
(805) 962-6616
Mailing address
915 N MILPAS ST, 2ND FLOOR, SANTA BARBARA, CA 93103-2331
(805) 617-7858
(805) 898-2002
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
050000113
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050000113
COMMUNITY CLINIC LICENSE
CA
01
—
05D0584453
CLIA NUMBER
CA
01
—
168904
CCS
CA
01
—
BCP70114G
CDP PROVIDER NUMBER
CA
01
—
CLN 1072
BOARD OF PHARMACY CLINIC PERMIT
CA
01
—
CLP 303897
DHS LAB REGISTRATION NUMBER
CA
01
—
EAP70114G
EAPC PROVIDER NUMBER
CA
05
—
FHC70114G
—
CA
01
—
HAP70114G
FAMPACT LEGACY NUMBER
CA
Enumeration date
07/14/2006
Last updated
03/03/2016
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