Healthcare Provider Details

I. General information

NPI: 1851729149
Provider Name (Legal Business Name): MARC REINOSO, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2809
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-5018
  • Fax:
Mailing address:
  • Phone: 805-652-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberG077260
License Number StateCA

VIII. Authorized Official

Name: DR. MARC REINOSO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-652-5018