Healthcare Provider Details

I. General information

NPI: 1679797757
Provider Name (Legal Business Name): HOMEDOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 PASEO DEL VALLE
CAMARILLO CA
93010-5950
US

IV. Provider business mailing address

380 PASEO DEL VALLE
CAMARILLO CA
93010-5950
US

V. Phone/Fax

Practice location:
  • Phone: 805-407-8728
  • Fax: 805-384-1330
Mailing address:
  • Phone: 805-407-8728
  • Fax: 805-384-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA30937
License Number StateCA

VIII. Authorized Official

Name: KSENIJA PEHARDA
Title or Position: PRESIDENT
Credential: MD
Phone: 805-407-8728