Provider Demographics
NPI:1770613697
Name:STORZ, JOAN N
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:N
Last Name:STORZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 RALSTON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6053
Mailing Address - Country:US
Mailing Address - Phone:805-658-2273
Mailing Address - Fax:805-644-4576
Practice Address - Street 1:5725 RALSTON ST STE 101
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6053
Practice Address - Country:US
Practice Address - Phone:805-658-2273
Practice Address - Fax:805-644-4576
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMS1189237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS63588Medicare UPIN