Provider Demographics
NPI:1225192743
Name:BUILDING BETTER LIVES OCCUPATIONAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:BUILDING BETTER LIVES OCCUPATIONAL MEDICAL SERVICES, INC.
Other - Org Name:VENTURA COUNTY OCCUPATIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:TOYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA-C
Authorized Official - Phone:805-988-2273
Mailing Address - Street 1:1901 HOLSER WALK
Mailing Address - Street 2:315
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2633
Mailing Address - Country:US
Mailing Address - Phone:805-988-2273
Mailing Address - Fax:805-981-8281
Practice Address - Street 1:1901 HOLSER WALK STE 315
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2633
Practice Address - Country:US
Practice Address - Phone:805-988-2273
Practice Address - Fax:805-981-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43187261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43187BMedicare UPIN