Healthcare Provider Details

I. General information

NPI: 1013919133
Provider Name (Legal Business Name): JEFFREY C BRACKETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRENT ST STE 301
VENTURA CA
93003-2836
US

IV. Provider business mailing address

100 N BRENT ST STE 301
VENTURA CA
93003-2836
US

V. Phone/Fax

Practice location:
  • Phone: 85-653-0101
  • Fax:
Mailing address:
  • Phone: 805-653-0101
  • Fax: 805-641-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA60080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: