Healthcare Provider Details

I. General information

NPI: 1679556906
Provider Name (Legal Business Name): ST.JOHN'S PLEASANT VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 ANTONIO AVE
CAMARILLO CA
93010-1414
US

IV. Provider business mailing address

2309 ANTONIO AVE
CAMARILLO CA
93010-1414
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-5853
  • Fax: 805-383-7464
Mailing address:
  • Phone: 805-389-5853
  • Fax: 805-383-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. ROSA VAZQUEZ
Title or Position: ACNE
Credential: RN
Phone: 805-389-5853