1649891052 NPI number — AQUILA HEALTHCARE SOLUTIONS, INC.

Table of content: (NPI 1649891052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649891052 NPI number — AQUILA HEALTHCARE SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AQUILA HEALTHCARE SOLUTIONS, 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:
Provider Other Organization Name Type Code:
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:
1649891052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 OUTLET CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93036-0677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-372-1113
Provider Business Mailing Address Fax Number:
805-233-3025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. JOHN'S REGIONAL MEDICAL CENTER - 1600 N ROSE AVE
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:
93030-3722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-988-2500
Provider Business Practice Location Address Fax Number:
805-233-3025
Provider Enumeration Date:
04/27/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BHATIA
Authorized Official First Name:
RAJAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
805-485-2400

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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