Healthcare Provider Details

I. General information

NPI: 1861232563
Provider Name (Legal Business Name): JOEPHILLIP ALVARADO LOBUSTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5964 SUNFLOWER ST
SIMI VALLEY CA
93063-5798
US

IV. Provider business mailing address

5964 SUNFLOWER ST
SIMI VALLEY CA
93063-5798
US

V. Phone/Fax

Practice location:
  • Phone: 805-624-0785
  • Fax:
Mailing address:
  • Phone: 805-624-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: