Provider Demographics
NPI:1841256427
Name:OJAI VALLEY FAMILY MEDICINE GROUP
Entity type:Organization
Organization Name:OJAI VALLEY FAMILY MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-646-7246
Mailing Address - Street 1:117 PIRIE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3166
Mailing Address - Country:US
Mailing Address - Phone:805-646-7246
Mailing Address - Fax:805-646-8936
Practice Address - Street 1:117 PIRIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:805-646-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49311YMedicaid
CAW5294Medicare ID - Type UnspecifiedFOR PRACTICE