Healthcare Provider Details

I. General information

NPI: 1376539130
Provider Name (Legal Business Name): LOMPOC VALLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N 3RD ST
LOMPOC CA
93436-6104
US

IV. Provider business mailing address

216 N 3RD ST
LOMPOC CA
93436-6104
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-3367
  • Fax:
Mailing address:
  • Phone: 805-737-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierZZT30110F
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 2
IdentifierZZT40110F
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 3
IdentifierZZT05256G
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: MR. DUSTIN CHENEY
Title or Position: CFO
Credential:
Phone: 805-737-3306