Provider Demographics
NPI:1063085678
Name:LOMA VISTA ENDOCRINOLOGY, INC.
Entity type:Organization
Organization Name:LOMA VISTA ENDOCRINOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WESTHOFF-PANKRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-667-3909
Mailing Address - Street 1:3555 LOMA VISTA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3161
Mailing Address - Country:US
Mailing Address - Phone:805-259-1356
Mailing Address - Fax:805-643-0720
Practice Address - Street 1:3555 LOMA VISTA RD STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-259-1356
Practice Address - Fax:805-643-0720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOMA VISTA ENDOCRINOLOGY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty