Provider Demographics
NPI:1952605396
Name:VENTURA MEDICAL, INC
Entity Type:Organization
Organization Name:VENTURA MEDICAL, INC
Other - Org Name:OC VISITING PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTAR-SEYEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-907-7686
Mailing Address - Street 1:3943 IRVINE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:949-900-6992
Mailing Address - Fax:949-900-6993
Practice Address - Street 1:3943 IRVINE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2400
Practice Address - Country:US
Practice Address - Phone:949-900-6992
Practice Address - Fax:949-900-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52547207R00000X
CA20A10469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEN251AOtherPTAN