Healthcare Provider Details

I. General information

NPI: 1366869471
Provider Name (Legal Business Name): JENNIFER LOEB SISCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MICHELLE LOEB MD

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 12/17/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOHN'S REGIONAL MEDICAL CENTER -1600 N ROSE AVENUE
OXNARD CA
93030
US

IV. Provider business mailing address

2020 ZONAL AVE # IRD723
LOS ANGELES CA
90089-0121
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax: 805-485-3025
Mailing address:
  • Phone: 323-409-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA148364
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA148364
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA148364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: