=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104389931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENTURA ORTHOPEDICS MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 E THOUSAND OAKS BLVD
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-379-4574
-----------------------------------------------------
Fax | 805-379-4324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1203 FLYNN RD UNIT 160
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-6203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-804-4168
-----------------------------------------------------
Fax | 805-830-1177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MINERVA BUTLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 805-941-0056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------