Healthcare Provider Details

I. General information

NPI: 1376959957
Provider Name (Legal Business Name): OXNARD INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6338 N MAROA AVE 113
FRESNO CA
93704-1554
US

IV. Provider business mailing address

6338 N MAROA AVE 113
FRESNO CA
93704-1554
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-7174
  • Fax:
Mailing address:
  • Phone: 559-274-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCPT00003318
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW MYLES III
Title or Position: CEO
Credential:
Phone: 559-274-7174