Provider Demographics
NPI:1316188253
Name:COUNTY OF VENTURA
Entity Type:Organization
Organization Name:COUNTY OF VENTURA
Other - Org Name:CONEJO VALLEY FAMILY MEDICAL GROUP FQHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-677-5272
Mailing Address - Street 1:800 S VICTORIA AVE # L4615
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0003
Mailing Address - Country:US
Mailing Address - Phone:805-677-5210
Mailing Address - Fax:
Practice Address - Street 1:125 W THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4402
Practice Address - Country:US
Practice Address - Phone:805-418-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENTURA COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH80CS00247-06-03261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051179Medicare Oscar/Certification