Basic Information
| Provider Information | |||||||||
| NPI: | 1881831766 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VENTURA CO HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3147 LOMA VISTA RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930032917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056489560 | ||||||||
| FaxNumber: | 8056489561 | ||||||||
| Practice Location | |||||||||
| Address1: | 3147 LOMA VISTA RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930032917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056489560 | ||||||||
| FaxNumber: | 8056489561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2009 | ||||||||
| LastUpdateDate: | 01/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | FISHER | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PUBLIC HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 8059815308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VENTURA COUNTY HEALTH CARE AGENCY | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | AYD000130 | 05 | CA | MEDICAID |