Healthcare Provider Details

I. General information

NPI: 1972623007
Provider Name (Legal Business Name): PDAP OF VENTURA COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 04/18/2016

III. Provider practice location address

450 ROSEWOOD AVENUE SUITE 215
CAMARILLO CA
93010-5914
US

IV. Provider business mailing address

1029 E SANTA PAULA ST
SANTA PAULA CA
93060-2247
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-1265
  • Fax: 805-389-5295
Mailing address:
  • Phone: 805-482-1265
  • Fax: 805-389-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number560015EN
License Number StateCA

VIII. Authorized Official

Name: VIRGINIA MARY CONNELL
Title or Position: EXECUTIVE DIRECTOR
Credential: MFT
Phone: 805-482-1265