Healthcare Provider Details

I. General information

NPI: 1134332307
Provider Name (Legal Business Name): WESTERN PACIFIC MED. CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E THOMPSON BLVD.
VENTURA CA
93001
US

IV. Provider business mailing address

3700 OLDS RD. #27
OXNARD CO
93033
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARK HICKMAN
Title or Position: C.E.O.
Credential:
Phone: 800-223-3869