1700944725 NPI number — PETER LORENZ MORRIS MD

Table of content: OLIVIA MARIE TASHO (NPI 1851160972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700944725 NPI number — PETER LORENZ MORRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRIS
Provider First Name:
PETER
Provider Middle Name:
LORENZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700944725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93002-2277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-650-5910
Provider Business Mailing Address Fax Number:
805-650-5972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PUEBLO AT BATH
Provider Second Line Business Practice Location Address:
SANTA BARBARA COTTAGE HOSPITAL
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-569-7367
Provider Business Practice Location Address Fax Number:
805-569-8354
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  C359560 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220006224 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ42967Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356409379 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0016631 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C359560 . This is a "MEDICAL BOARD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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