# LOMPOC VALLEY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649282856
- **Authorized official:** JIM WHITE (CIO)
- **Authorized official phone:** (805) 737-3300

## Contact information

- **Practice address:** 136 N 3RD ST, LOMPOC, CA 93436-7002
- **Practice address phone:** (805) 736-1253
- **Practice address fax:** (805) 736-3193
- **Mailing address:** 1515 E OCEAN AVE, LOMPOC, CA 93436-7092
- **Mailing address phone:** (805) 736-1253
- **Mailing address fax:** (805) 736-3193

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/13/2006
- **Last updated:** 12/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ37313Z | BLUE SHIELD | CA |
| 05 | — | ZZZ37313Z | — | CA |