Healthcare Provider Details

I. General information

NPI: 1750873113
Provider Name (Legal Business Name): VENTURA COUNTY COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 CAMPUS RD
MOORPARK CA
93021-1605
US

IV. Provider business mailing address

7075 CAMPUS ROAD STUDENT HEALTH SERVICES
MOORPARK CA
93021-1605
US

V. Phone/Fax

Practice location:
  • Phone: 805-378-1413
  • Fax: 805-378-1570
Mailing address:
  • Phone: 805-378-1413
  • Fax: 805-378-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON L MANAKAS
Title or Position: DIRECTOR, STUDENTS HEALTH PROGRAM
Credential: MSN, RN
Phone: 805-378-1413