Provider Demographics
NPI:1225494636
Name:LOMA VISTA ENDOCRINOLOGY, INC.
Entity Type:Organization
Organization Name:LOMA VISTA ENDOCRINOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WESTHOFF-PRANKRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-259-1356
Mailing Address - Street 1:2629 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1548
Mailing Address - Country:US
Mailing Address - Phone:805-259-1356
Mailing Address - Fax:805-259-1357
Practice Address - Street 1:2629 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1548
Practice Address - Country:US
Practice Address - Phone:805-259-1356
Practice Address - Fax:805-259-1357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA066887OtherMEDICAL LICENSE