Healthcare Provider Details

I. General information

NPI: 1114985363
Provider Name (Legal Business Name): PRIMARY CRITICAL CARE LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 ANTONIO AVE
CAMARILLO CA
93010-1438
US

IV. Provider business mailing address

PO BOX 998
NORTH HOLLYWOOD CA
91603-0998
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-5800
  • Fax:
Mailing address:
  • Phone: 818-509-2222
  • Fax: 818-509-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE T GIPE
Title or Position: PRESIDENT AND GENERAL PARTNER
Credential: MD
Phone: 818-509-2222