Healthcare Provider Details

I. General information

NPI: 1891766820
Provider Name (Legal Business Name): ERIC W TRUBSCHENCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 E FIR AVE
LOMPOC CA
93436-7919
US

IV. Provider business mailing address

917 E FIR AVE
LOMPOC CA
93436-7919
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-2510
  • Fax: 805-736-4224
Mailing address:
  • Phone: 805-736-2510
  • Fax: 805-736-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG34762
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39315
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number223604
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD425699
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier000000358791
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 2
Identifier64096977
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: