Healthcare Provider Details

I. General information

NPI: 1609361427
Provider Name (Legal Business Name): MATTHEW WESTFALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 JOHNSON DR STE 100
VENTURA CA
93003-7261
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2809
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-1430
  • Fax: 833-916-2136
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: