Provider Demographics
NPI:1003836545
Name:BUENA VISTA FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BUENA VISTA FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:X
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-485-9123
Mailing Address - Street 1:719 N A ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4309
Mailing Address - Country:US
Mailing Address - Phone:805-485-9123
Mailing Address - Fax:
Practice Address - Street 1:719 N A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4309
Practice Address - Country:US
Practice Address - Phone:805-485-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56329261QM1300X, 261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563290Medicaid
CAZZZ772002OtherBLUE SHIELD PROVIDER NUM
CA00A563290Medicaid
CAH31365Medicare UPIN
CA00A563290Medicaid
CA=========OtherCOMMERCIAL PROVIDER NUMB