Organization
LOMPOC VALLEY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM WHITE (CIO)
(805) 737-3300
Entity
Organization
Contact information
Practice address
136 N 3RD ST, LOMPOC, CA 93436-7002
(805) 736-1253
(805) 736-3193
Mailing address
1515 E OCEAN AVE, LOMPOC, CA 93436-7092
(805) 736-1253
(805) 736-3193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ37313Z
BLUE SHIELD
CA
05
—
ZZZ37313Z
—
CA
Enumeration date
08/13/2006
Last updated
12/23/2020
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