Provider Demographics
NPI:1962629501
Name:CALIFORNIA COMPLETE CARE NETWORK
Entity Type:Organization
Organization Name:CALIFORNIA COMPLETE CARE NETWORK
Other - Org Name:CCCN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-642-4135
Mailing Address - Street 1:90 N ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1810
Mailing Address - Country:US
Mailing Address - Phone:805-642-4135
Mailing Address - Fax:805-642-9117
Practice Address - Street 1:90 N ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1810
Practice Address - Country:US
Practice Address - Phone:805-642-4135
Practice Address - Fax:805-642-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty