1891735486 NPI number — DR. CHARLES HOCHETTE AVERY M.D.

Table of content: DR. CHARLES HOCHETTE AVERY M.D. (NPI 1891735486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891735486 NPI number — DR. CHARLES HOCHETTE AVERY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVERY
Provider First Name:
CHARLES
Provider Middle Name:
HOCHETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1891735486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2772 JOHNSON DR STE 200
Provider Second Line Business Mailing Address:
ATTN CINDY GARNER
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-7262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-641-1430
Provider Business Mailing Address Fax Number:
805-642-1436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1751 LOMBARD ST # A
Provider Second Line Business Practice Location Address:
ATTN CINDY GARNER
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-8266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-981-9111
Provider Business Practice Location Address Fax Number:
805-981-8333
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A26091 , 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)

  • Identifier: W13268 . This is a "PRIMARY MEDICAL MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W13268A . This is a "PRIMARY MEDICAL MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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