MEDICARE: FAMILY TO FAMILY MEDICAL CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043298490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TO FAMILY MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	970 PETIT AVE
Second Line	:	SUITE D
City	:	VENTURA
State	:	CA
Zip	:	93004-2215
Country	:	US
Telephone Number	:	805-659-1166
Fax Number	:	805-659-5765

Provider Business Practice Location Address
First Line	:	970 PETIT AVE
Second Line	:	SUITE D
City	:	VENTURA
State	:	CA
Zip	:	93004-2215
Country	:	US
Telephone Number	:	805-659-1166
Fax Number	:	805-659-5765

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KRISTIN S PENA
Credential	:	M.D.
Telephone Number	:	805-659-1166

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/22/2020

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