Provider Demographics
NPI:1649385311
Name:PLUCHE, LYNN S (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:S
Last Name:PLUCHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MOBIL AVENUE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-445-3310
Mailing Address - Fax:805-445-3309
Practice Address - Street 1:400 MOBIL AVENUE
Practice Address - Street 2:SUITE C2
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-445-3310
Practice Address - Fax:805-445-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60940Medicaid
CAW13742Medicare ID - Type Unspecified
CA00AX60940Medicaid