Provider Demographics
NPI:1720447568
Name:COUNTY OF VENTURA
Entity Type:Organization
Organization Name:COUNTY OF VENTURA
Other - Org Name:LAS ISLAS FAMILY MEDICAL GROUP FQHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NARCISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-677-5140
Mailing Address - Street 1:133 W SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2543
Mailing Address - Country:US
Mailing Address - Phone:805-648-9562
Mailing Address - Fax:
Practice Address - Street 1:325 W CHANNEL ISLANDS BLVD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-4501
Practice Address - Country:US
Practice Address - Phone:805-204-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VENTURA COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH80CS00247-06-03261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050159Medicare Oscar/Certification