Provider Demographics
NPI:1710989835
Name:STORZ, SIEGFRIED O (MD)
Entity Type:Individual
Prefix:DR
First Name:SIEGFRIED
Middle Name:O
Last Name:STORZ
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 1:168 N BRENT ST
Mailing Address - Street 2:STE 503
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2840
Mailing Address - Country:US
Mailing Address - Phone:805-653-0101
Mailing Address - Fax:805-641-0434
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:STE 503
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2840
Practice Address - Country:US
Practice Address - Phone:805-653-0101
Practice Address - Fax:805-641-0434
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001490Medicaid
A40354Medicare UPIN
CAGR0001490Medicaid