Healthcare Provider Details

I. General information

NPI: 1982983169
Provider Name (Legal Business Name): COUNTY OF VENTURA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 LOMA VISTA RD
VENTURA CA
93003-2917
US

IV. Provider business mailing address

800 S VICTORIA AVE # L4615
VENTURA CA
93009-0003
US

V. Phone/Fax

Practice location:
  • Phone: 58-652-6694
  • Fax: 805-652-6298
Mailing address:
  • Phone: 805-677-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberH80CS00247
License Number StateCA

VIII. Authorized Official

Name: THERESA CHO
Title or Position: DIRECTOR
Credential: MD
Phone: 805-677-5290