Healthcare Provider Details

I. General information

NPI: 1942312194
Provider Name (Legal Business Name): OXNARD MTU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 VIA MARINA AVE
OXNARD CA
93035-2437
US

IV. Provider business mailing address

3150 VIA MARINA AVE
OXNARD CA
93035-2437
US

V. Phone/Fax

Practice location:
  • Phone: 805-382-1784
  • Fax: 805-984-0590
Mailing address:
  • Phone: 805-382-1784
  • Fax: 805-984-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURELL MAURO
Title or Position: MANAGER
Credential: PT
Phone: 805-981-5223