Provider Demographics
NPI:1861232563
Name:LOBUSTA, JOEPHILLIP ALVARADO
Entity type:Individual
Prefix:
First Name:JOEPHILLIP
Middle Name:ALVARADO
Last Name:LOBUSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5964 SUNFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5798
Mailing Address - Country:US
Mailing Address - Phone:805-624-0785
Mailing Address - Fax:
Practice Address - Street 1:5964 SUNFLOWER ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5798
Practice Address - Country:US
Practice Address - Phone:805-624-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE140548146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic