Provider Demographics
NPI:1407032451
Name:VENTURA SPINE INSTITUTE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VENTURA SPINE INSTITUTE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-208-8192
Mailing Address - Street 1:974 VIA BARON
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6798
Mailing Address - Country:US
Mailing Address - Phone:805-208-8192
Mailing Address - Fax:805-273-4282
Practice Address - Street 1:974 VIA BARON
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6798
Practice Address - Country:US
Practice Address - Phone:805-208-8192
Practice Address - Fax:805-273-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty