Healthcare Provider Details
I. General information
NPI: 1679897755
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF VENTURA COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3291 LOMA VISTA RD
VENTURA CA
93003-3099
US
IV. Provider business mailing address
3116 W MARCH LN STE 200
STOCKTON CA
95219-2369
US
V. Phone/Fax
- Phone: 805-652-6656
- Fax: 805-652-6286
- Phone: 209-473-6555
- Fax: 209-473-6544
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DAVID
J.
FISHMAN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 209-473-6555