Healthcare Provider Details

I. General information

NPI: 1063085678
Provider Name (Legal Business Name): LOMA VISTA ENDOCRINOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 LOMA VISTA RD STE 100
VENTURA CA
93003-3161
US

IV. Provider business mailing address

3555 LOMA VISTA RD STE 100
VENTURA CA
93003-3161
US

V. Phone/Fax

Practice location:
  • Phone: 805-259-1356
  • Fax: 805-643-0720
Mailing address:
  • Phone: 805-259-1356
  • Fax: 805-643-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRICIA LYN WESTHOFF-PANKRATZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 805-667-3909