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General NPI Number Information
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NPI Number | 1508253469
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Entity Type | Organization
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Legal Business Name | VENTURA COUNTY CENTER FOR FUNCTIONAL WELLNESS INC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 4087 MISSION OAKS BLVD STE B
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City | CAMARILLO
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State | CA
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Zip | 93012-5156
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Country | US
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Telephone | 805-484-1077
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Fax | 805-484-1079
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Provider Business Mailing Address
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Address Line | 4087 MISSION OAKS BLVD STE B
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City | CAMARILLO
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State | CA
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Zip | 93012-5156
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Country | US
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Telephone | 805-484-1077
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Fax | 805-484-1079
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MELANIE L BROWN
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Credential |
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Telephone | 805-484-1077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A108091
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License Number State | CA
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