| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2400 S C St, Oxnard, California |
| Authorized Official Name and Position | Theresa Cho (DIRECTOR) |
| Authorized Official Contact | 8056775290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
800 S Victoria Ave # L4615 Ventura CA 93009-0001 Ph: (805) 677-5210 | 2400 S C St Oxnard CA 93033 Ph: (805) 240-7000 |
| NPI Number | 1952542896 |
|---|---|
| Provider Enumeration Date | 03/23/2009 |
| Last Update Date | 07/19/2024 |
| Medicare PECOS PAC ID | 7911810171 |
|---|---|
| Medicare Enrollment ID | O20090717000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952542896 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | H80CS00247-06-03 (California) | Primary |
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