Provider Demographics
NPI:1902834393
Name:WESTHOFF-PANKRATZ, TRICIA LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:LYN
Last Name:WESTHOFF-PANKRATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRICIA
Other - Middle Name:LYN
Other - Last Name:WESTHOFF-PANKRATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2629 LOMA VISTA RD.
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-259-1356
Mailing Address - Fax:805-259-1357
Practice Address - Street 1:2629 LOMA VISTA RD.
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-259-1356
Practice Address - Fax:805-259-1357
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66887207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH16751Medicare UPIN
H16751Medicare UPIN
CACB249651Medicare Oscar/Certification