Provider Demographics
NPI:1336141175
Name:VENTURA EAR NOSE & THROAT MED GROUP INC
Entity Type:Organization
Organization Name:VENTURA EAR NOSE & THROAT MED GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-648-3320
Mailing Address - Street 1:3555 LOMA VISTA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3161
Mailing Address - Country:US
Mailing Address - Phone:056-483-3208
Mailing Address - Fax:805-648-2659
Practice Address - Street 1:3555 LOMA VISTA RD STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:056-483-3208
Practice Address - Fax:805-648-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27589207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13309OtherRAILROAD MEDICARE
ZZZ97008ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0066460Medicaid
13309OtherRAILROAD MEDICARE