Healthcare Provider Details

I. General information

NPI: 1104971472
Provider Name (Legal Business Name): WESTSIDE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST SUITE A
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

400 E SANTA BARBARA ST SUITE A
SANTA PAULA CA
93060-2675
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-2121
  • Fax: 805-525-3652
Mailing address:
  • Phone: 805-525-2121
  • Fax: 805-525-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANICE J LAMBERT
Title or Position: MANAGER
Credential:
Phone: 805-525-2121