Healthcare Provider Details

I. General information

NPI: 1699563981
Provider Name (Legal Business Name): DAVID VALLEJO PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 09/11/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 TELEGRAPH RD
VENTURA CA
93003-4298
US

IV. Provider business mailing address

255 W STANLEY AVE
VENTURA CA
93001-1313
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-1826
  • Fax:
Mailing address:
  • Phone: 805-641-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: