Basic Information
| Provider Information | |||||||||
| NPI: | 1558318881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | HARVEY | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5855 OLIVAS PARK DR | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672801 | ||||||||
| FaxNumber: | 8056672865 | ||||||||
| Practice Location | |||||||||
| Address1: | 2921 SAVIERS RD | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930335314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054875588 | ||||||||
| FaxNumber: | 8055875589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | C38214 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207Q00000X | C38214 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | RHM18553H | 05 | CA | MEDICAID | 050394 | 01 | CA | BLUE CROSS | OTHER | ZZT40394F | 05 | CA | MEDICAID | RHM08608F | 05 | CA | MEDICAID | RHM08609F | 05 | CA | MEDICAID | 95-1683892 | 01 | CA | OTHER INSURANCE | OTHER |