Healthcare Provider Details

I. General information

NPI: 1083771349
Provider Name (Legal Business Name): WILLIAM A SPEITEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date: 10/27/2009
Reactivation Date: 05/03/2011

III. Provider practice location address

124 N BRENT ST
VENTURA CA
93003-2810
US

IV. Provider business mailing address

124 N BRENT ST
VENTURA CA
93003-2810
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-9880
  • Fax: 805-641-9890
Mailing address:
  • Phone: 805-641-9880
  • Fax: 805-641-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34840
License Number StateCA

VIII. Authorized Official

Name: PAM SPEITEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-641-9880