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General NPI Number Information
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NPI Number | 1124067574
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEMORIAL HEALTH SYSTEM
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 250 CITRUS GROVE LN #150
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City | OXNARD
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State | CA
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Zip | 93036-9030
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Country | US
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Telephone | 805-981-3770
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Fax | 805-981-3767
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Provider Business Mailing Address
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Address Line | 5855 OLIVAS PARK DR
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City | VENTURA
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State | CA
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Zip | 93003-7672
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Country | US
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Telephone | 805-667-2801
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Fax | 805-667-2865
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Authorized Official
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Title or Position | CEO
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Name | MR. GARY WILDE
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Credential |
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Telephone | 805-652-5011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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