Provider Demographics
NPI:1104409267
Name:SENNING, GREGORY P (PA-C)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:SENNING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:SENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:3525 LOMA VISTA RD STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3165
Practice Address - Country:US
Practice Address - Phone:805-804-4168
Practice Address - Fax:805-830-1177
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60092OtherSTATE LICENSE