Healthcare Provider Details

I. General information

NPI: 1386200103
Provider Name (Legal Business Name): FUJIMORA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S VENTURA RD STE 40
OXNARD CA
93030-6552
US

IV. Provider business mailing address

PO BOX 312
OXNARD CA
93032-0312
US

V. Phone/Fax

Practice location:
  • Phone: 805-382-8000
  • Fax: 805-382-8002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE HERRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-382-8000