Basic Information
| Provider Information | |||||||||
| NPI: | 1861943805 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF VENTURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2323 KNOLL DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5851 THILLE ST | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930035414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | FISHER | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | HEALTH CARE AGENCY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056775272 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF VENTURA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.