Healthcare Provider Details

I. General information

NPI: 1336141175
Provider Name (Legal Business Name): VENTURA EAR NOSE & THROAT MED GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 LOMA VISTA RD STE 200
VENTURA CA
93003-3161
US

IV. Provider business mailing address

3555 LOMA VISTA RD STE 200
VENTURA CA
93003-3161
US

V. Phone/Fax

Practice location:
  • Phone: 56-483-3208
  • Fax: 805-648-2659
Mailing address:
  • Phone: 56-483-3208
  • Fax: 805-648-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC27589
License Number StateCA

VIII. Authorized Official

Name: DR. ARMIN ALAVI
Title or Position: OWNER
Credential:
Phone: 805-648-3320