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General NPI Number Information
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NPI Number | 1962405860
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Entity Type | Organization
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Legal Business Name | PMK MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1700 N ROSE AVE STE 320
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City | OXNARD
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State | CA
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Zip | 93030-7648
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Country | US
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Telephone | 805-485-8709
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Fax | 805-485-5521
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Provider Business Mailing Address
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Address Line | 1700 N ROSE AVE STE 320
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City | OXNARD
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State | CA
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Zip | 93030-7648
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Country | US
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Telephone | 805-485-8709
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Fax | 805-485-5521
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Authorized Official
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Title or Position | FINANCE & QUALITY OFFICER
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Name | MARISSA RIVERA
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Credential | MBA
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Telephone | 805-485-8709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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