Healthcare Provider Details

I. General information

NPI: 1447659933
Provider Name (Legal Business Name): COUNTY OF VENTURA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY DR
CAMARILLO CA
93012-8599
US

IV. Provider business mailing address

800 S VICTORIA AVE # L4615
VENTURA CA
93009-0003
US

V. Phone/Fax

Practice location:
  • Phone: 805-437-8828
  • Fax: 805-437-8829
Mailing address:
  • Phone: 805-677-5210
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHNSON GILL
Title or Position: CEO
Credential:
Phone: 805-677-5272