Provider Demographics
NPI:1083751200
Name:CHANNEL ISLANDS FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:CHANNEL ISLANDS FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PADUVILAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NARAYANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:805-984-0144
Mailing Address - Street 1:2800 S VENTURA RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-4905
Mailing Address - Country:US
Mailing Address - Phone:805-984-0144
Mailing Address - Fax:805-487-7445
Practice Address - Street 1:2800 S VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4905
Practice Address - Country:US
Practice Address - Phone:805-984-0144
Practice Address - Fax:805-487-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35301207R00000X
CAA35200208D00000X
CAFNP13657261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016240Medicaid
CAGR0016240Medicaid