Healthcare Provider Details

I. General information

NPI: 1346327517
Provider Name (Legal Business Name): LA MER PSYCHIATRIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 OUTLET CENTER DR SUITE 220
OXNARD CA
93036-0663
US

IV. Provider business mailing address

PO BOX 201
CAMARILLO CA
93011-0201
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-8330
  • Fax: 805-388-8030
Mailing address:
  • Phone: 805-388-8330
  • Fax: 805-388-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JERRY BRUNS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 805-388-8330