Provider Demographics
NPI:1083743652
Name:VENTURA COUNTY OBSTETRIC AND GYNECOLOGIC MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:VENTURA COUNTY OBSTETRIC AND GYNECOLOGIC MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRENA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-643-8695
Mailing Address - Street 1:2795 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1544
Mailing Address - Country:US
Mailing Address - Phone:805-643-8695
Mailing Address - Fax:805-643-2087
Practice Address - Street 1:2795 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1544
Practice Address - Country:US
Practice Address - Phone:805-643-8695
Practice Address - Fax:805-643-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6193Medicare PIN