Provider Demographics
NPI:1205000957
Name:WARMUTH, MARK J (CO)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:WARMUTH
Suffix:
Gender:M
Credentials:CO
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Mailing Address - Street 1:4517 MARKET ST
Mailing Address - Street 2:STE 4
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7710
Mailing Address - Country:US
Mailing Address - Phone:805-658-1822
Mailing Address - Fax:805-658-1824
Practice Address - Street 1:4517 MARKET ST
Practice Address - Street 2:STE 4
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7710
Practice Address - Country:US
Practice Address - Phone:805-658-1822
Practice Address - Fax:805-658-1824
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CACO1535222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0015350Medicaid