Healthcare Provider Details

I. General information

NPI: 1609800747
Provider Name (Legal Business Name): JAMES LEONARD VERWEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E BETTERAVIA RD STE C
SANTA MARIA CA
93454-7847
US

IV. Provider business mailing address

1400 E. CHURCH STREET MEDICAL STAFF OFFICE
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-0561
  • Fax:
Mailing address:
  • Phone: 805-739-3954
  • Fax: 805-739-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA25003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: