1972623007 NPI number — PDAP OF VENTURA COUNTY, INC.

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 1972623007 NPI number — PDAP OF VENTURA COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PDAP OF VENTURA COUNTY, 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:
6
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:
1972623007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
04/18/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1029 E SANTA PAULA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA PAULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93060-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-482-1265
Provider Business Mailing Address Fax Number:
805-389-5295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 ROSEWOOD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-5914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-482-1265
Provider Business Practice Location Address Fax Number:
805-389-5295
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONNELL
Authorized Official First Name:
VIRGINIA
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
805-482-1265

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  560015EN , 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: 5673 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com