Provider Demographics
NPI:1629005475
Name:SIU, PATRICK K (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:K
Last Name:SIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LOMA VISTA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1581
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:422 ARNEILL RD STE B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6434
Practice Address - Country:US
Practice Address - Phone:805-383-4510
Practice Address - Fax:805-383-4511
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 4738207PE0004X
CAG86731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01348502Medicaid
CARHM08609FMedicaid
HID0014375OtherSHIELD/HMSA
CA050394OtherBLUE CROSS
CARHM18553HMedicaid
CARHM08608FMedicaid
CAZZT40394FMedicaid
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
HI101248Medicare ID - Type Unspecified
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CA050394Medicare ID - Type UnspecifiedMEDICARE
CARHM08609FMedicaid
CARHM08608FMedicaid
HI01348502Medicaid