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NPI Code Detail

MEDICARE: PMK MEDICAL GROUP, INC.

MEDICARE: PMK 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
1261QX0200XOncology Clinic/Center
2207RH0003XHematology & Oncology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4W13337OTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ZZZ45387ZOTHERCABLUE SHIELD PROVIDER
35628497OTHERCANCPDP/NPDS

General Provider Information

NPI Number : 1962405860
Entity Type Code : Organization
Provider Name (Legal Business Name) : PMK MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 1700 N ROSE AVE
Second Line : STE 320
City : OXNARD
State : CA
Zip : 93030-7648
Country : US
Telephone Number : 805-485-8709
Fax Number : 805-485-5521
Provider Business Practice Location Address
First Line : 1700 N ROSE AVE STE 320
Second Line :
City : OXNARD
State : CA
Zip : 93030-7648
Country : US
Telephone Number : 805-485-8709
Fax Number : 805-485-5521
Authorized Official
Title or Position : FINANCE & QUALITY OFFICER
Name : MARISSA RIVERA
Credential : MBA
Telephone Number : 805-485-8709
Provider Enumeration Date : 05/24/2005
Last Update Date : 11/26/2025

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Directions to “PMK MEDICAL GROUP, INC. ” Practice Location

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