Provider Demographics
NPI: | 1942312194 |
---|---|
Name: | OXNARD MTU |
Entity Type: | Organization |
Organization Name: | OXNARD MTU |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MAURO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 805-981-5223 |
Mailing Address - Street 1: | 3150 VIA MARINA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | OXNARD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93035-2437 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-382-1784 |
Mailing Address - Fax: | 805-984-0590 |
Practice Address - Street 1: | 3150 VIA MARINA AVE |
Practice Address - Street 2: | |
Practice Address - City: | OXNARD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93035-2437 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-382-1784 |
Practice Address - Fax: | 805-984-0590 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | COUNTY OF VENTURA |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-08-31 |
Last Update Date: | 2008-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | CCS00019F | Other | MEDICAL |