Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 13450 | CA |
NPI | 1528125028 |
---|---|
Provider Name | Dr. Jacob Bastomski |
First Address | Santa Barbara, CA 93101-2539 |
Second Address | Santa Barbara, CA 93101-2539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 26/02/2008 |