Healthcare Provider Details

I. General information

NPI: 1699408187
Provider Name (Legal Business Name): VENTURA FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 07/02/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD STE 103
SIMI VALLEY CA
93065-6509
US

IV. Provider business mailing address

2828 COCHRAN ST STE 355
SIMI VALLEY CA
93065-2780
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-1286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDIP GILL
Title or Position: SECRETARY
Credential: MD
Phone: 310-927-1286