Provider Demographics
NPI:1710966684
Name:VANTERPOOL, JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:
Last Name:VANTERPOOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 PROFESSIONAL PKWY
Mailing Address - Street 2:SUTIE 260
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1629
Mailing Address - Country:US
Mailing Address - Phone:805-348-3950
Mailing Address - Fax:805-348-3901
Practice Address - Street 1:2342 PROFESSIONAL PKWY
Practice Address - Street 2:SUTIE 260
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1629
Practice Address - Country:US
Practice Address - Phone:805-348-3950
Practice Address - Fax:805-348-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7290306OtherAETNA US HEALTHCARE
CAA75691OtherBLUE CROSS
CA00A756910OtherBLUE SHIELD OF CALIFORNIA
CA00A756910OtherBLUE SHIELD OF CALIFORNIA
WA75691CMedicare PIN
7290306OtherAETNA US HEALTHCARE