Healthcare Provider Details

I. General information

NPI: 1548285307
Provider Name (Legal Business Name): OXNARD CAMARILLO ANESTHESIOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ANTONIO AVE
CAMARILLO CA
93010-1414
US

IV. Provider business mailing address

3116 W MARCH LN STE. 200
STOCKTON CA
95219-2369
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2500
  • Fax:
Mailing address:
  • Phone: 209-473-6555
  • Fax: 209-473-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JON P. BELLEVILLE
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 310-440-3131