Provider Demographics
NPI:1811076961
Name:TUSHLA, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:TUSHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050394OtherBLUE CROSS
CAZZT40394FMedicaid
CARHM08608FMedicaid
CARHM18553HMedicaid
CARHM08609FMedicaid
CAG12974Medicare UPIN
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CARHM08609FMedicaid
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CAWA54473EMedicare ID - Type UnspecifiedPPIN
CAWA54473GMedicare ID - Type UnspecifiedPPIN
CARHM18553HMedicaid
CAWA54473IMedicare ID - Type UnspecifiedPPIN
CAWA54473JMedicare ID - Type UnspecifiedPPIN
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CAZZT40394FMedicaid