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General NPI Number Information
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NPI Number | 1508943903
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Entity Type | Organization
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Legal Business Name | NORTHRIDGE MEDICAL GROUP
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1901 SOLAR DR SUITE 265
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City | OXNARD
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State | CA
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Zip | 93036-2641
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Country | US
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Telephone | 805-988-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 SOLAR DR SUITE 265
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City | OXNARD
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State | CA
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Zip | 93036-2641
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Country | US
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Telephone | 805-988-2280
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARY MCCORMACK
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Credential |
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Telephone | 818-444-5273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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