Basic Information
| Provider Information | |||||||||
| NPI: | 1548419674 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEZEMA | ||||||||
| FirstName: | ERIK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2705 LOMA VISTA RD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672801 | ||||||||
| FaxNumber: | 8056672865 | ||||||||
| Practice Location | |||||||||
| Address1: | 138 W MAIN ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930012584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056672850 | ||||||||
| FaxNumber: | 8056520708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2008 | ||||||||
| LastUpdateDate: | 09/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A103644 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.