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General NPI Number Information
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NPI Number | 1346065976
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Entity Type | Organization
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Legal Business Name | PRIMARY MEDICAL GROUP OF VENTURA
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 117 PIRIE RD STE D
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City | OJAI
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State | CA
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Zip | 93023-3166
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Country | US
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Telephone | 805-646-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 26 S GARDEN ST STE I
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City | VENTURA
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State | CA
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Zip | 93001-4524
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Country | US
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Telephone | 805-507-2225
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SHERILYN CHANTAL WHEATON
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Credential |
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Telephone | 805-647-7704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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