Healthcare Provider Details

I. General information

NPI: 1952481053
Provider Name (Legal Business Name): LUPE YEPEZ- MICHEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W MAIN ST SUITE E
VENTURA CA
93001-2584
US

IV. Provider business mailing address

2705 LOMA VISTA RD SUITE 205
VENTURA CA
93003-1581
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-2850
  • Fax: 805-652-0708
Mailing address:
  • Phone: 805-667-2801
  • Fax: 805-641-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number500919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: