Provider Demographics
NPI:1851418677
Name:VENTURA ADVANCED SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:VENTURA ADVANCED SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-639-3984
Mailing Address - Street 1:3200 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3232
Mailing Address - Country:US
Mailing Address - Phone:805-639-3984
Mailing Address - Fax:530-432-4915
Practice Address - Street 1:10956 DONNER PASS RD STE 310
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:805-639-3984
Practice Address - Fax:530-432-4915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03783ZMedicare ID - Type Unspecified
CAF33676Medicare UPIN