Healthcare Provider Details

I. General information

NPI: 1215591920
Provider Name (Legal Business Name): VENTURA COUNTY PODIATRIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N A STREET
OXNARD CA
93030-4309
US

IV. Provider business mailing address

451 W GONZALES RD STE 260
OXNARD CA
93036-0729
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0222
  • Fax: 805-604-9872
Mailing address:
  • Phone: 805-485-6708
  • Fax: 805-278-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SCOT ROBERG
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 805-485-6708