Organization
JEFFREY K. LUTTRULL, M. D. A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY KEVIN LUTTRULL (PRESIDENT)
(805) 650-0664
Entity
Organization
Contact information
Practice address
3160 TELEGRAPH RD STE 230, VENTURA, CA 93003-3252
(805) 650-0664
Mailing address
3160 TELEGRAPH RD STE 230, VENTURA, CA 93003-3252
(805) 650-0664
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7015319
MEDI-CAL
CA
Enumeration date
02/15/2008
Last updated
07/21/2022
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