1952542896 NPI number — COUNTY OF VENTURA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952542896 NPI number — COUNTY OF VENTURA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF VENTURA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAS ISLAS FAMILY MEDICAL GROUP NORTH FQHC
Provider Other Organization Name Type Code:
3
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:
1952542896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S VICTORIA AVE # L4615
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:
93009-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-677-5210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 S C ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-240-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
805-677-5272

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  H80CS00247-06-03 , 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)





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