Provider Demographics
NPI:1093705279
Name:OXNARD - CAMARILLO PULMONARY AND INTERNAL MEDICINE MEDICAL GROUP
Entity Type:Organization
Organization Name:OXNARD - CAMARILLO PULMONARY AND INTERNAL MEDICINE MEDICAL GROUP
Other - Org Name:OXNARD - CAMARILLO PULMONARY AND INTERNAL MEDICINE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-485-2340
Mailing Address - Street 1:703 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:805-485-2340
Mailing Address - Fax:805-485-1429
Practice Address - Street 1:703 NORTH 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:805-485-2340
Practice Address - Fax:805-485-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ2801852Medicaid
CAW1153Medicare PIN