Provider Demographics
NPI:1013191253
Name:VENTURA COUNTY GASTROENTEROLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:VENTURA COUNTY GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING / CODER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-983-0521
Mailing Address - Street 1:2486 PONDEROSA DRIVE NORTH
Mailing Address - Street 2:SUITE D-206
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-983-0521
Mailing Address - Fax:805-983-4186
Practice Address - Street 1:2486 N PONDEROSA DR
Practice Address - Street 2:SUITE D-206
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2376
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:805-983-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0800075083207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty