Healthcare Provider Details

I. General information

NPI: 1669464715
Provider Name (Legal Business Name): CAMARILLO SPRINGS HOLISTIC MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 CAMARILLO SPRINGS RD #E
CAMARILLO CA
93012-9441
US

IV. Provider business mailing address

816 CAMARILLO SPRINGS RD #E
CAMARILLO CA
93012-9441
US

V. Phone/Fax

Practice location:
  • Phone: 805-987-1800
  • Fax: 805-987-5311
Mailing address:
  • Phone: 805-987-1800
  • Fax: 805-987-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES A AYLOR
Title or Position: SECRETARY
Credential: DC
Phone: 805-987-1800