Provider Demographics
NPI:1417970849
Name:PRIMARY MEDICAL GROUP OF VENTURA COUNTY INC
Entity Type:Organization
Organization Name:PRIMARY MEDICAL GROUP OF VENTURA COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-652-0659
Mailing Address - Street 1:2772 JOHNSON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7262
Mailing Address - Country:US
Mailing Address - Phone:805-642-1430
Mailing Address - Fax:805-642-1436
Practice Address - Street 1:3555 LOMA VISTA RD
Practice Address - Street 2:#110
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-653-0303
Practice Address - Fax:805-653-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ44782ZOtherBLUE SHIELD (TELEGRAPH)
CAW13268Other3555 LOMA VISTA RD, #110, VENTURA, CA 93003
CAZZZ44783ZOtherBLUE SHIELD (LOMA VISTA )
CAW13268Other2953 TELEGRAPH RD, VENTURA, CA 93003
CAW13268AOther10885 TELEGRAPH ROAD, VENTURA CA 93004
CAW13268Other2772 JOHNSON DR #200, VENTURA, CA 93003
CAW13268Other1751 LOMBARD ST #A, OXNARD CA 93030