Healthcare Provider Details

I. General information

NPI: 1194505230
Provider Name (Legal Business Name): COMMUNITY PHYSICIANS OF VENTURA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LOMA VISTA RD STE F
VENTURA CA
93003-1811
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD A REISMAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 805-643-8695