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General NPI Number Information
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NPI Number | 1376607846
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Entity Type | Individual
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Provider Name | JOHN IPPOLITO M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 612 SPRING RD BLDG A
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City | MOORPARK
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State | CA
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Zip | 93021-1298
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Country | US
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Telephone | 805-523-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S VICTORIA AVE # L4640
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City | VENTURA
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State | CA
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Zip | 93009-3099
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Country | US
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Telephone | 805-677-5146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G78738
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License Number State | CA
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