MEDICARE: OXNARD MTU

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	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CCS00019F	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1942312194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OXNARD MTU

Provider Business Mailing Address
First Line	:	3150 VIA MARINA AVE
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-2437
Country	:	US
Telephone Number	:	805-382-1784
Fax Number	:	805-984-0590

Provider Business Practice Location Address
First Line	:	3150 VIA MARINA AVE
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-2437
Country	:	US
Telephone Number	:	805-382-1784
Fax Number	:	805-984-0590

Authorized Official
Title or Position	:	MANAGER
Name	:	LAURELL MAURO
Credential	:	PT
Telephone Number	:	805-981-5223

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/18/2008

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Directions to “OXNARD MTU ” Practice Location

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