Provider Demographics
NPI:1174554620
Name:VENTURA COUNTY GASTROENTEROLOGY MEDICAL GRP INC
Entity type:Organization
Organization Name:VENTURA COUNTY GASTROENTEROLOGY MEDICAL GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-983-0521
Mailing Address - Street 1:PO BOX 50640
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-0640
Mailing Address - Country:US
Mailing Address - Phone:805-983-0521
Mailing Address - Fax:805-983-4186
Practice Address - Street 1:2241 WANKEL WAY
Practice Address - Street 2:STE A
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0191
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:805-983-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2289Medicare ID - Type Unspecified