Provider Demographics
NPI:1669464715
Name:CAMARILLO SPRINGS HOLISTIC MEDICAL
Entity Type:Organization
Organization Name:CAMARILLO SPRINGS HOLISTIC MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-987-1800
Mailing Address - Street 1:816 CAMARILLO SPRINGS RD
Mailing Address - Street 2:#E
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9441
Mailing Address - Country:US
Mailing Address - Phone:805-987-1800
Mailing Address - Fax:805-987-5311
Practice Address - Street 1:816 CAMARILLO SPRINGS RD
Practice Address - Street 2:#E
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9441
Practice Address - Country:US
Practice Address - Phone:805-987-1800
Practice Address - Fax:805-987-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14172Medicare ID - Type Unspecified