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General NPI Number Information
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NPI Number | 1679451488
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Entity Type | Organization
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Legal Business Name | USCG AIRSTA VENTURA
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 190 3RD STREET
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City | NAVAL AIR STATION POINT MUGU
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State | CA
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Zip | 93042
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Country | US
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Telephone | 805-874-3260
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Fax |
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Provider Business Mailing Address
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Address Line | 190 3RD STREET
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City | NAVAL AIR STATION POINT MUGU
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State | CA
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Zip | 93042
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Country | US
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Telephone | 805-874-3260
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Fax |
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Authorized Official
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Title or Position | HEALTH SERVICES ADMINISTRATOR
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Name | RENEE R ESHAM
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Credential | HS1
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Telephone | 805-502-9989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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