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General NPI Number Information
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NPI Number | 1790967404
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE & PEDIATRICS PRIVATE PRACTICE, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 3687 LAS POSAS RD SUITE H-187
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City | CAMARILLO
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State | CA
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Zip | 93010-1482
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Country | US
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Telephone | 805-445-4189
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Fax | 805-445-9219
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Provider Business Mailing Address
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Address Line | 3687 LAS POSAS RD SUITE H-187
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City | CAMARILLO
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State | CA
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Zip | 93010-1482
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Country | US
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Telephone | 805-445-4189
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Fax | 805-445-9219
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RAGU NATHAN
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Credential | J.D.
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Telephone | 818-671-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A053595
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A053595
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License Number State | CA
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