Provider Demographics
NPI:1376779249
Name:VENTURA TRAUMA/SURGICAL CRITICAL CARE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VENTURA TRAUMA/SURGICAL CRITICAL CARE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KIMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-988-7077
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-988-7077
Mailing Address - Fax:
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-988-7077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO671352086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty