Provider Demographics
NPI:1235995085
Name:MEDICAL KITCHEN
Entity Type:Organization
Organization Name:MEDICAL KITCHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-218-1746
Mailing Address - Street 1:4850 VERDUGO WAY STE B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012
Mailing Address - Country:US
Mailing Address - Phone:805-218-1746
Mailing Address - Fax:
Practice Address - Street 1:4850 VERDUGO WAY STE B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-218-1746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier
No174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals