1629531454 NPI number — VENTURA ORTHOPEDICS MEDICAL GROUP, INC.

Table of content: (NPI 1629531454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629531454 NPI number — VENTURA ORTHOPEDICS MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VENTURA ORTHOPEDICS MEDICAL GROUP, INC.
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:
VENTURA ORTHOPEDICS
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:
1629531454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5720 RALSTON ST STE 200
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:
93003-7844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-804-4168
Provider Business Mailing Address Fax Number:
805-830-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 ERRINGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93065-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-527-1404
Provider Business Practice Location Address Fax Number:
805-527-5246
Provider Enumeration Date:
04/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
805-941-0056

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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