Healthcare Provider Details

I. General information

NPI: 1104389931
Provider Name (Legal Business Name): VENTURA ORTHOPEDICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91360-5707
US

IV. Provider business mailing address

1203 FLYNN RD UNIT 160
CAMARILLO CA
93012-6203
US

V. Phone/Fax

Practice location:
  • Phone: 805-379-4574
  • Fax: 805-379-4324
Mailing address:
  • Phone: 805-804-4168
  • Fax: 805-830-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MINERVA BUTLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 805-941-0056