Provider Demographics
NPI:1104971472
Name:WESTSIDE FAMILY PRACTICE
Entity type:Organization
Organization Name:WESTSIDE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-525-2121
Mailing Address - Street 1:400 E SANTA BARBARA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2675
Mailing Address - Country:US
Mailing Address - Phone:805-525-2121
Mailing Address - Fax:805-525-3652
Practice Address - Street 1:400 E SANTA BARBARA ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2675
Practice Address - Country:US
Practice Address - Phone:805-525-2121
Practice Address - Fax:805-525-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285671206OtherNPI
CAGR0024030Medicaid
CAW10034Medicare ID - Type UnspecifiedWESTSIDE FAMILY PRACTICE
1285671206OtherNPI
CAH34082Medicare UPIN
CAGR0024030Medicaid