Provider Demographics
NPI:1134132897
Name:HATCH, LANETTE A (MSPAC)
Entity Type:Individual
Prefix:MS
First Name:LANETTE
Middle Name:A
Last Name:HATCH
Suffix:
Gender:F
Credentials:MSPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 MADERA RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3053
Mailing Address - Country:US
Mailing Address - Phone:805-522-5722
Mailing Address - Fax:805-915-4141
Practice Address - Street 1:200 S WELLS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1377
Practice Address - Country:US
Practice Address - Phone:805-659-1740
Practice Address - Fax:805-659-9959
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P90407Medicare UPIN
W3731EMedicare ID - Type Unspecified