Healthcare Provider Details

I. General information

NPI: 1952471906
Provider Name (Legal Business Name): WTP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

IV. Provider business mailing address

401 E CYPRESS AVE
LOMPOC CA
93436-6806
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-7723
  • Fax: 805-737-7726
Mailing address:
  • Phone: 805-737-7723
  • Fax: 805-737-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. CAROL KAY VAWTER
Title or Position: INSTRUCTOR
Credential:
Phone: 805-737-7723