Provider Demographics
NPI:1104184407
Name:VENTURA COUNTY MEDICAL MANAGED CARE COMMISION
Entity Type:Organization
Organization Name:VENTURA COUNTY MEDICAL MANAGED CARE COMMISION
Other - Org Name:GOLD COAST HEALTH PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-981-5320
Mailing Address - Street 1:2220 E. GONZALES ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036
Mailing Address - Country:US
Mailing Address - Phone:805-981-5320
Mailing Address - Fax:805-981-5314
Practice Address - Street 1:2220 E. GONZALES ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-981-5320
Practice Address - Fax:805-981-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA302R00000XOtherCOUNTY ORGANIZED HEALTHCARE SYSTEM