Healthcare Provider Details

I. General information

NPI: 1467554873
Provider Name (Legal Business Name): LOMPOC VALLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E OCEAN AVE
LOMPOC CA
93436-7092
US

IV. Provider business mailing address

1515 E OCEAN AVE
LOMPOC CA
93436-7092
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-3337
  • Fax: 805-737-3352
Mailing address:
  • Phone: 805-737-3337
  • Fax: 805-737-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHPE21884
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHAD SIGNORELLI
Title or Position: DIR PHCY SVS
Credential: PHARM D
Phone: 805-737-3337