Healthcare Provider Details

I. General information

NPI: 1265462246
Provider Name (Legal Business Name): BUENAVENTURA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S HILL RD
VENTURA CA
93003-8400
US

IV. Provider business mailing address

2590 E MAIN ST
VENTURA CA
93003-2619
US

V. Phone/Fax

Practice location:
  • Phone: 805-477-6464
  • Fax: 805-477-6498
Mailing address:
  • Phone: 805-477-6464
  • Fax: 805-477-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES G MALONE
Title or Position: CEO
Credential:
Phone: 805-477-6220