Healthcare Provider Details

I. General information

NPI: 1396595245
Provider Name (Legal Business Name): LOMPOC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N H ST
LOMPOC CA
93436-6021
US

IV. Provider business mailing address

215 N H ST STE B
LOMPOC CA
93436-6037
US

V. Phone/Fax

Practice location:
  • Phone: 805-406-3627
  • Fax:
Mailing address:
  • Phone: 805-888-4511
  • Fax: 805-888-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
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: POLLY J BALDWIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-588-7984