Provider Demographics
NPI:1720345614
Name:HEALTHSTAT ON-SITE CLINIC/REITER OXNARD
Entity Type:Organization
Organization Name:HEALTHSTAT ON-SITE CLINIC/REITER OXNARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:704-529-6161
Mailing Address - Street 1:4601 CHARLOTTE PARK DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1915
Mailing Address - Country:US
Mailing Address - Phone:704-529-6161
Mailing Address - Fax:
Practice Address - Street 1:300 W 5TH ST.
Practice Address - Street 2:SUITE A
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-240-7547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty