Healthcare Provider Details

I. General information

NPI: 1861585887
Provider Name (Legal Business Name): ERIC MARTIN MOLL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT SREET
VENTURA CA
93003
US

IV. Provider business mailing address

960 PENINSULA ST
VENTURA CA
93001-3954
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5011
  • Fax: 805-585-3007
Mailing address:
  • Phone: 805-652-5018
  • Fax: 805-650-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberG68497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: