Basic Information
| Provider Information | |||||||||
| NPI: | 1528236791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VENTURA COUNTY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S VICTORIA AVE # L4615 | ||||||||
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| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930090003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 HILLMONT AVE | ||||||||
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| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | MILSTIEN | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DEPUTY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056526058 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 05D0701603 | CA | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | LAB01063F | 05 | CA | MEDICAID |