Healthcare Provider Details

I. General information

NPI: 1881009124
Provider Name (Legal Business Name): JENNIFER VINSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2809
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5672
  • Fax: 805-585-3060
Mailing address:
  • Phone: 805-652-5672
  • Fax: 805-585-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: