=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629005475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK K SIU M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 422 ARNEILL RD STE B
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-6434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-383-4510
-----------------------------------------------------
Fax | 805-383-4511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2705 LOMA VISTA RD SUITE 205
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-1581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-667-2801
-----------------------------------------------------
Fax | 805-667-2865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number | MD 4738
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G86731
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------