MEDICARE: JOEPHILLIP ALVARADO LOBUSTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		CA

General Provider Information

NPI Number	:	1861232563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEPHILLIP ALVARADO LOBUSTA

Provider Business Mailing Address
First Line	:	5964 SUNFLOWER ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5798
Country	:	US
Telephone Number	:	805-624-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	5964 SUNFLOWER ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-5798
Country	:	US
Telephone Number	:	805-624-0785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	06/27/2026

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