Healthcare Provider Details

I. General information

NPI: 1043422694
Provider Name (Legal Business Name): AMERICAN TRADE MARK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S A ST
OXNARD CA
93030-7139
US

IV. Provider business mailing address

851 S A ST
OXNARD CA
93030-7139
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-7244
  • Fax: 805-385-7246
Mailing address:
  • Phone: 805-385-7244
  • Fax: 805-385-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MARK KOVALIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-385-7244