Healthcare Provider Details

I. General information

NPI: 1174698351
Provider Name (Legal Business Name): JILL E. FURGURSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

23941 DE VILLE WAY
MALIBU CA
90265-4894
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5051
  • Fax: 805-585-3007
Mailing address:
  • Phone: 310-456-3036
  • Fax: 310-456-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberG36815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: