=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083898142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MNS MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 04/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3291 LOMA VISTA RD
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-642-8565
-----------------------------------------------------
Fax | 805-642-8564
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3418 LOMA VISTA RD STE A
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-642-8565
-----------------------------------------------------
Fax | 805-642-8564
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MGR
-----------------------------------------------------
Name | MAGALY CHAVEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-642-8565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------