Healthcare Provider Details

I. General information

NPI: 1922853324
Provider Name (Legal Business Name): VENTURA HARBOR RESTAURANT ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 ANCHORS WAY DR
VENTURA CA
93001-6282
US

IV. Provider business mailing address

200 N WESTLAKE BLVD STE 100
WESTLAKE VILLAGE CA
91362-3771
US

V. Phone/Fax

Practice location:
  • Phone: 805-612-0202
  • Fax:
Mailing address:
  • Phone: 805-612-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MR. ORESTIS SIMOS
Title or Position: DIRECTOR OF OPERATIONS, CFO
Credential:
Phone: 805-612-0202