MEDICARE: VENTURA COUNTY PODIATRIC MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E3640	OTHER	CA	CA STATE LICENSE

General Provider Information

NPI Number	:	1215591920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENTURA COUNTY PODIATRIC MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	451 W GONZALES RD STE 260
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-485-6708
Fax Number	:	805-278-2299

Provider Business Practice Location Address
First Line	:	451 W GONZALES RD STE 260
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-983-0222
Fax Number	:	805-604-9872

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SCOT ROBERG
Credential	:	DPM
Telephone Number	:	805-485-6708

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	04/16/2026

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Directions to “VENTURA COUNTY PODIATRIC MEDICAL GROUP INC ” Practice Location

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