Provider Demographics
NPI:1174749295
Name:MISSION MEDICAL CARE OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:MISSION MEDICAL CARE OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:805-247-1811
Mailing Address - Street 1:300 W 5TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0000
Mailing Address - Country:US
Mailing Address - Phone:805-247-1811
Mailing Address - Fax:805-483-7981
Practice Address - Street 1:300 W 5TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0000
Practice Address - Country:US
Practice Address - Phone:805-247-1811
Practice Address - Fax:805-483-7981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty