| Medstat Inc | |
|
430 Park Ave Port Hueneme CA 93041-2553 | |
| (805) 487-3881 | |
| (561) 286-5137 |
| Full Name | Medstat Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 430 Park Ave, Port Hueneme, California |
| Authorized Official Name and Position | Gregorio L De Grano (CEO) |
| Authorized Official Contact | 8185168066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medstat Inc 430 Park Ave Port Hueneme CA 93041-2553 Ph: (805) 487-3881 | Medstat Inc 430 Park Ave Port Hueneme CA 93041-2553 Ph: (805) 487-3881 |
| NPI Number | 1609362227 |
|---|---|
| Provider Enumeration Date | 07/06/2018 |
| Last Update Date | 12/27/2023 |
| Medicare PECOS PAC ID | 7315379229 |
|---|---|
| Medicare Enrollment ID | O20191114002157 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609362227 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Doddanna Krishna |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1285725945 PECOS PAC ID: 2163546136 Enrollment ID: I20100826001173 |
| Provider Name | Gregorio De Grano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417392176 PECOS PAC ID: 6507005121 Enrollment ID: I20130611000838 |
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