Healthcare Provider Details

I. General information

NPI: 1427434570
Provider Name (Legal Business Name): BRIAN MARK UTZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 E MAIN ST
VENTURA CA
93003
US

IV. Provider business mailing address

5855 OLIVAS PARK DR
VENTURA CA
93003-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-667-2841
  • Fax:
Mailing address:
  • Phone: 805-667-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A15078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: