Healthcare Provider Details

I. General information

NPI: 1962405860
Provider Name (Legal Business Name): PMK MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 320
OXNARD CA
93030-7648
US

IV. Provider business mailing address

1700 N ROSE AVE STE 320
OXNARD CA
93030-7648
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-8709
  • Fax: 805-485-5521
Mailing address:
  • Phone: 805-485-8709
  • Fax: 805-485-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARISSA RIVERA
Title or Position: FINANCE & QUALITY OFFICER
Credential: MBA
Phone: 805-485-8709