Provider Demographics
NPI:1467554873
Name:LOMPOC VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:LOMPOC VALLEY MEDICAL CENTER
Other - Org Name:LOMPOC VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PHCY SVS
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:805-737-3337
Mailing Address - Street 1:1515 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7092
Mailing Address - Country:US
Mailing Address - Phone:805-737-3337
Mailing Address - Fax:805-737-3352
Practice Address - Street 1:1515 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7092
Practice Address - Country:US
Practice Address - Phone:805-737-3337
Practice Address - Fax:805-737-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAHPE218843336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22T05256GMedicaid
2050145OtherPK